Provider Demographics
NPI:1366626228
Name:WL MEDICAL PC
Entity Type:Organization
Organization Name:WL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIMENG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-867-6681
Mailing Address - Street 1:820 2ND AVE
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4502
Mailing Address - Country:US
Mailing Address - Phone:212-867-6681
Mailing Address - Fax:347-332-1651
Practice Address - Street 1:820 2ND AVE
Practice Address - Street 2:SUITE 6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4502
Practice Address - Country:US
Practice Address - Phone:212-867-6681
Practice Address - Fax:347-332-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234541302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06852Medicare PIN
NYI 23893Medicare UPIN