Provider Demographics
NPI:1326135468
Name:HSU, WEN-RAY T (MD)
Entity Type:Individual
Prefix:
First Name:WEN-RAY
Middle Name:T
Last Name:HSU
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 1:18 ANDREA LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3108
Mailing Address - Country:US
Mailing Address - Phone:914-472-3541
Mailing Address - Fax:
Practice Address - Street 1:301 E 21ST ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6505
Practice Address - Country:US
Practice Address - Phone:212-477-4907
Practice Address - Fax:212-477-4944
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227696207R00000X
NY243841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400004620OtherMEDICARE PTAN
NY03082799Medicaid
MAA40657Medicare PIN
MA165363Medicare UPIN