MEDICARE: JEAN K WOO RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	014165-1	NY

General Provider Information

NPI Number	:	1033426945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN K WOO RPA-C

Provider Business Mailing Address
First Line	:	444 MERRICK RD STE LL2
Second Line	:
City	:	LYNBROOK
State	:	NY
Zip	:	11563-2400
Country	:	US
Telephone Number	:	516-599-4498
Fax Number	:	516-887-6647

Provider Business Practice Location Address
First Line	:	15921 CROSS BAY BLVD
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3121
Country	:	US
Telephone Number	:	718-641-7575
Fax Number	:	718-641-7576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	05/07/2021

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