MEDICARE: DENNIS WANG PT

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	225100000X	Physical Therapist	0156181	NY
2	2251P0200X	Pediatric Physical Therapist	0156181	NY

General Provider Information

NPI Number	:	1699913509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS WANG PT

Provider Business Mailing Address
First Line	:	3420 79TH ST APT 6J
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2610
Country	:	US
Telephone Number	:	917-295-8307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 79TH ST APT 6J
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2610
Country	:	US
Telephone Number	:	917-295-8307
Fax Number	:

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	01/30/2009

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Directions to “ DENNIS WANG PT” Practice Location

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