MEDICARE: DR. BENEDICT CHANG WU D.O./PHD.

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	207N00000X	Dermatology Physician	W000-063-82-386-0	FL
2	207R00000X	Internal Medicine Physician	OT017295	PA
3	207N00000X	Dermatology Physician	308444-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HS000293L	OTHER	PA	EMPLOYEE NUMBER

General Provider Information

NPI Number	:	1730538596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENEDICT CHANG WU D.O./PHD.

Provider Business Mailing Address
First Line	:	3411 WAYNE AVE FL 2D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2535
Country	:	US
Telephone Number	:	718-920-8493
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 BAINBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1402
Country	:	US
Telephone Number	:	718-920-8493
Fax Number	:

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

Provider Enumeration Date	:	06/11/2016
Last Update Date	:	03/12/2023

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