Provider Demographics
NPI:1497183834
Name:WU, TAO (MD)
Entity Type:Individual
Prefix:
First Name:TAO
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1225
Mailing Address - Country:US
Mailing Address - Phone:646-820-4866
Mailing Address - Fax:855-285-8006
Practice Address - Street 1:825 57TH ST STE 103
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3674
Practice Address - Country:US
Practice Address - Phone:646-820-4866
Practice Address - Fax:855-285-8006
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04220971Medicaid