Provider Demographics
NPI:1619288065
Name:WANG, ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BOWERY
Mailing Address - Street 2:1ST FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 BOWERY
Practice Address - Street 2:1ST FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4297
Practice Address - Country:US
Practice Address - Phone:212-335-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09209200207RC0000X
NY282507207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease