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NPI Code Detail

MEDICARE: MR. WAI LIN W MO P.A.

MEDICARE: MR. WAI LIN W MO P.A.
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
1363A00000XPhysician Assistant012921NY

General Provider Information

NPI Number : 1174768550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WAI LIN W MO P.A.
Provider Business Mailing Address
First Line : 392 SEGUINE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-3906
Country : US
Telephone Number : 718-226-3804
Fax Number :
Provider Business Practice Location Address
First Line : 392 SEGUINE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-3906
Country : US
Telephone Number : 718-226-3804
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2008
Last Update Date : 12/13/2011

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