Provider Demographics
NPI:1578655288
Name:WANG, JOHN CL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CL
Last Name:WANG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:504 E 74TH ST STE 506
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3486
Mailing Address - Country:US
Mailing Address - Phone:212-249-4061
Mailing Address - Fax:212-249-4659
Practice Address - Street 1:505 E 70TH ST
Practice Address - Street 2:2ND FLR.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-746-1578
Practice Address - Fax:212-746-8483
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY147032207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00957424Medicaid
NYE48865Medicare UPIN
NY00957424Medicaid