MEDICARE: WANG'S MEDICAL P.C.

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	208000000X	Pediatrics Physician	240727	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240727	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1730356080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANG'S MEDICAL P.C.

Provider Business Mailing Address
First Line	:	5423 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3122
Country	:	US
Telephone Number	:	718-871-8885
Fax Number	:	718-871-8883

Provider Business Practice Location Address
First Line	:	5423 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3122
Country	:	US
Telephone Number	:	718-871-8885
Fax Number	:	718-871-8883

Authorized Official
Title or Position	:	MD
Name	:	ZHAO H. WANG
Credential	:
Telephone Number	:	718-871-8885

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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