Provider Demographics
NPI:1497113047
Name:WOHLBERG, YING LIU
Entity Type:Individual
Prefix:
First Name:YING
Middle Name:LIU
Last Name:WOHLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YING
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3332 WALDEN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-2400
Mailing Address - Country:US
Mailing Address - Phone:716-668-7051
Mailing Address - Fax:716-668-7069
Practice Address - Street 1:656 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222
Practice Address - Country:US
Practice Address - Phone:716-883-0515
Practice Address - Fax:716-883-8764
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130245363LP2300X
NYF307799-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care