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General NPI Number Information
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NPI Number | 1184255481
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Entity Type | Organization
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Legal Business Name | WOLF RIDGE MEDICAL WELLNESS
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 100 NEW BROADWAY APT 404
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City | RENSSELAER
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State | NY
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Zip | 12144-2159
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Country | US
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Telephone | 401-575-3534
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Fax |
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Provider Business Mailing Address
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Address Line | 100 NEW BROADWAY APT 404
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City | RENSSELAER
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State | NY
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Zip | 12144-2159
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Country | US
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Telephone | 401-575-3534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN TSANG
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Credential | MD
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Telephone | 401-575-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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