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General NPI Number Information
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NPI Number | 1568121283
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Entity Type | Organization
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Legal Business Name | JW ESSENCE MEDICAL PLLC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 13620 MAPLE AVE STE C303
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City | FLUSHING
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State | NY
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Zip | 11355-5166
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Country | US
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Telephone | 917-348-0698
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 UNION ST APT 1F
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City | FLUSHING
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State | NY
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Zip | 11355-7031
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Country | US
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Telephone | 917-348-0698
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JIANG WANG
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Credential | DO
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Telephone | 718-210-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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