Provider Demographics
NPI:1326121070
Name:WANG, SHUANGPING (MD)
Entity Type:Individual
Prefix:
First Name:SHUANGPING
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1007
Mailing Address - Country:US
Mailing Address - Phone:845-986-7885
Mailing Address - Fax:845-986-7496
Practice Address - Street 1:5 GRAND ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1007
Practice Address - Country:US
Practice Address - Phone:845-986-7885
Practice Address - Fax:845-986-7496
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02166681Medicaid