Provider Demographics
NPI:1629091426
Name:WANG, GINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 22ND ST UNIT DR5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4616
Mailing Address - Country:US
Mailing Address - Phone:212-682-3602
Mailing Address - Fax:212-213-8060
Practice Address - Street 1:235 E 22ND ST UNIT DR5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4616
Practice Address - Country:US
Practice Address - Phone:212-682-3602
Practice Address - Fax:212-213-8060
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01737920Medicaid
NY1780859785OtherNPI
NY01737920Medicaid
NYWGW601Medicare ID - Type Unspecified