Provider Demographics
NPI:1376824698
Name:WU, WINSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WIN
Other - Middle Name:KO KO
Other - Last Name:OO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13324 SANFORD AVE
Mailing Address - Street 2:SUITE 1 K
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3650
Mailing Address - Country:US
Mailing Address - Phone:917-754-5481
Mailing Address - Fax:
Practice Address - Street 1:13324 SANFORD AVE
Practice Address - Street 2:SUITE 1 K
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3650
Practice Address - Country:US
Practice Address - Phone:917-754-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03799891Medicaid