Provider Demographics
NPI:1174664643
Name:LNW MEDICAL OFFICE, PLLC
Entity Type:Organization
Organization Name:LNW MEDICAL OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WEINING
Authorized Official - Middle Name:
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-1552
Mailing Address - Street 1:13604 NORTHERN BLVD STE CU3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6515
Mailing Address - Country:US
Mailing Address - Phone:718-578-6718
Mailing Address - Fax:
Practice Address - Street 1:33 WALT WHITMAN RD STE 100A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3631
Practice Address - Country:US
Practice Address - Phone:718-321-7558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203586170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01849985Medicaid
NY01849985Medicaid