MEDICARE: DR. WINFRED Y WU MD, MPH

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	2083P0901X	Public Health & General Preventive Medicine Physician	234560	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	234560	OTHER	NY	NYS MEDICAL LICENSE

General Provider Information

NPI Number	:	1205910452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINFRED Y WU MD, MPH

Provider Business Mailing Address
First Line	:	65 BAYLOR AVE
Second Line	:
City	:	HILLSDALE
State	:	NJ
Zip	:	07642-1741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 28TH ST
Second Line	:	12TH FLOOR (CN-52)
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-396-4916
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	11/26/2012

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