MEDICARE: SHIUSH-CHAU WANG MD

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	207Q00000X	Family Medicine Physician	116201	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	24374	OTHER		AAFP

General Provider Information

NPI Number	:	1689754343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIUSH-CHAU WANG MD

Provider Business Mailing Address
First Line	:	882 FLUSHING AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-4601
Country	:	US
Telephone Number	:	718-821-2250
Fax Number	:	718-821-9341

Provider Business Practice Location Address
First Line	:	882 FLUSHING AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-4601
Country	:	US
Telephone Number	:	718-821-2250
Fax Number	:	718-821-9341

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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