Provider Demographics
NPI:1558409037
Name:WU, DING WEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DING WEN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 STEWART PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3033
Mailing Address - Country:US
Mailing Address - Phone:516-326-0195
Mailing Address - Fax:
Practice Address - Street 1:1200 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2723
Practice Address - Country:US
Practice Address - Phone:516-369-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227632207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI20774Medicare UPIN
NY58R841Medicare ID - Type Unspecified