Provider Demographics
NPI:1407306152
Name:WANG, EMMA MINGZHU
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MINGZHU
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINGZHU
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136-26 37TH AVENUE
Mailing Address - Street 2:CBWCHC
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3746
Mailing Address - Country:US
Mailing Address - Phone:718-886-1212
Mailing Address - Fax:718-886-2568
Practice Address - Street 1:136-26 37TH AVENUE
Practice Address - Street 2:CBWCHC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3746
Practice Address - Country:US
Practice Address - Phone:718-886-1212
Practice Address - Fax:718-886-2568
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPW66993NMedicaid