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General NPI Number Information
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NPI Number | 1780406611
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Entity Type | Organization
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Legal Business Name | REGO PARK FAMILY HEALTH NP PC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 6475 AUSTIN ST APT M1
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City | REGO PARK
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State | NY
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Zip | 11374-4195
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Country | US
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Telephone | 347-436-8335
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Fax |
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Provider Business Mailing Address
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Address Line | 17020 CROCHERON AVE APT 106
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City | FLUSHING
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State | NY
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Zip | 11358-2268
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Country | US
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Telephone | 929-642-9110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRACE WANG
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Credential | FNP-BC
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Telephone | 929-642-9110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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