MEDICARE: HAISU WANG

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1497223895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAISU WANG

Provider Business Mailing Address
First Line	:	236 W 135TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 ROCHESTER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3102
Country	:	US
Telephone Number	:	718-771-2090
Fax Number	:

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

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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Directions to “ HAISU WANG ” Practice Location

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