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General NPI Number Information
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NPI Number | 1770886921
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Entity Type | Organization
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Legal Business Name | DR. DA WANG PSYCHIATRIC CONSULTATION, P.C.
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 13336 41ST RD STE 1B
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City | FLUSHING
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State | NY
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Zip | 11355-3661
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Country | US
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Telephone | 516-581-9835
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Fax |
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Provider Business Mailing Address
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Address Line | 11 WILLETS DR
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City | SYOSSET
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State | NY
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Zip | 11791-3913
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Country | US
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Telephone | 516-581-9835
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DA WANG
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Credential | M.D.
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Telephone | 516-581-9835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 256826
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License Number State | NY
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