MEDICARE: REGO PARK FAMILY HEALTH NP PC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1780406611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGO PARK FAMILY HEALTH NP PC

Provider Business Mailing Address
First Line	:	17020 CROCHERON AVE APT 106
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2268
Country	:	US
Telephone Number	:	929-642-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	6475 AUSTIN ST APT M1
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4195
Country	:	US
Telephone Number	:	347-436-8335
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GRACE WANG
Credential	:	FNP-BC
Telephone Number	:	929-642-9110

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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