MEDICARE: WL MEDICAL PC

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	234541	NY

General Provider Information

NPI Number	:	1366626228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WL MEDICAL PC

Provider Business Mailing Address
First Line	:	820 2ND AVE
Second Line	:	SUITE 6A
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	212-867-6681
Fax Number	:	347-332-1651

Provider Business Practice Location Address
First Line	:	820 2ND AVE
Second Line	:	SUITE 6A
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	212-867-6681
Fax Number	:	347-332-1651

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LIMENG WANG
Credential	:	M.D.
Telephone Number	:	212-867-6681

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	01/25/2023

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