Provider Demographics
NPI:1619943248
Name:WANG, BEVERLY Y (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:Y
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1724
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:770-666-9097
Practice Address - Street 1:10 NATHAN D PERLMAN PLACE
Practice Address - Street 2:SUITE 12S34
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3851
Practice Address - Country:US
Practice Address - Phone:212-420-2124
Practice Address - Fax:212-420-3449
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209288207ZP0101X, 207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02460750Medicaid
NYA400054876OtherNGS
NYH12245Medicare UPIN
NYA400054876OtherNGS
NYA400054874Medicare PIN