Provider Demographics
NPI:1417446113
Name:WU, ANDREW YA (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:YA
Last Name:WU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BROADHOLLOW RD STE M102
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3719
Mailing Address - Country:US
Mailing Address - Phone:631-249-2481
Mailing Address - Fax:631-249-2482
Practice Address - Street 1:535 BROADHOLLOW RD STE M102
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3719
Practice Address - Country:US
Practice Address - Phone:631-249-2481
Practice Address - Fax:631-249-2482
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001482171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist