MEDICARE: WL EQUITY LLC

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	302F00000X	Exclusive Provider Organization	A234541	NY

General Provider Information

NPI Number	:	1073913968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WL EQUITY LLC

Provider Business Mailing Address
First Line	:	820 2ND AVE
Second Line	:	6A
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	917-838-1032
Fax Number	:	347-332-1651

Provider Business Practice Location Address
First Line	:	820 2ND AVE
Second Line	:	6A
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	917-838-1032
Fax Number	:	718-732-4566

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. LIMENG WANG
Credential	:
Telephone Number	:	917-838-1032

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/27/2014

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Directions to “WL EQUITY LLC ” Practice Location

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