Provider Demographics
NPI:1003035494
Name:WANG, RUI
Entity Type:Individual
Prefix:
First Name:RUI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PLAZA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3640
Mailing Address - Country:US
Mailing Address - Phone:607-798-7680
Mailing Address - Fax:607-238-7713
Practice Address - Street 1:4000 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 209
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6631
Practice Address - Country:US
Practice Address - Phone:315-329-7666
Practice Address - Fax:315-632-4597
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001723171100000X
NY001723-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist