Provider Demographics
NPI:1114918182
Name:WU, DARRYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ELIZABETH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4637
Mailing Address - Country:US
Mailing Address - Phone:212-925-7757
Mailing Address - Fax:212-925-7756
Practice Address - Street 1:41 ELIZABETH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4637
Practice Address - Country:US
Practice Address - Phone:212-925-7757
Practice Address - Fax:212-925-7756
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02161728Medicaid