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General NPI Number Information
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NPI Number | 1538772157
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Entity Type | Organization
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Legal Business Name | WILZEN ANNE LINGAD O.D., PLLC
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 4117 CRESCENT ST
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-3861
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Country | US
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Telephone | 718-786-5892
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Fax | 929-273-1044
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Provider Business Mailing Address
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Address Line | 386 WARREN ST APT 2L
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City | BROOKLYN
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State | NY
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Zip | 11201-6524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILZEN A LINGAD
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Credential | OD
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Telephone | 917-675-2263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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