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General NPI Number Information
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NPI Number | 1255513487
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Entity Type | Organization
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Legal Business Name | GRACE MEDICAL CARE, PLLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 13347 SANFORD AVE STE C1G
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City | FLUSHING
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State | NY
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Zip | 11355-5816
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Country | US
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Telephone | 718-886-7888
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Fax | 718-886-9120
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Provider Business Mailing Address
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Address Line | 48 KENSINGTON CIR
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City | MANHASSET
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State | NY
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Zip | 11030-4106
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Country | US
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Telephone | 718-886-7888
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Fax | 718-886-9120
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Authorized Official
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Title or Position | PRESIDENT
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Name | BIN WANG
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Credential | MD
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Telephone | 718-886-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 217425
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License Number State | NY
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