Provider Demographics
NPI:1033325063
Name:WILLIAM WANG MEDICAL P.C
Entity Type:Organization
Organization Name:WILLIAM WANG MEDICAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-445-8884
Mailing Address - Street 1:43-73 UNION ST
Mailing Address - Street 2:UNITS 1B & 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3063
Mailing Address - Country:US
Mailing Address - Phone:718-445-8884
Mailing Address - Fax:718-445-1776
Practice Address - Street 1:43-73 UNION STREET
Practice Address - Street 2:UNITS 1B & 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-445-8884
Practice Address - Fax:718-445-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220245225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02137213Medicaid
NYH34989Medicare UPIN
NY02137213Medicaid
NY04600Medicare ID - Type Unspecified