MEDICARE: SALLY WEN MD

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	207R00000X	Internal Medicine Physician	332788	NY

General Provider Information

NPI Number	:	1063156669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY WEN MD

Provider Business Mailing Address
First Line	:	743 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3916
Country	:	US
Telephone Number	:	917-715-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3916
Country	:	US
Telephone Number	:	718-765-0088
Fax Number	:

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

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	10/09/2025

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