Provider Demographics
NPI:1477891901
Name:DR WW DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:DR WW DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUACHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-457-0002
Mailing Address - Street 1:87-01 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4831
Mailing Address - Country:US
Mailing Address - Phone:718-457-0002
Mailing Address - Fax:718-457-9108
Practice Address - Street 1:87-01 56TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4831
Practice Address - Country:US
Practice Address - Phone:718-457-0002
Practice Address - Fax:718-457-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215477174400000X
NY218668174400000X
NY014078363A00000X
NY014997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285921320OtherINDIVIDUAL NPI
NY1588752521OtherINDIVIDUAL NPI
NY1235167313OtherINDIVIDUAL NPI
NY1518299965OtherINDIVIDUAL NPI
NYG400064356Medicare PIN
NYA400063418Medicare PIN
NY1235167313OtherINDIVIDUAL NPI
NYA400063663Medicare PIN
NY1588752521OtherINDIVIDUAL NPI
NYA400063784Medicare PIN
NYG400064359Medicare PIN