Provider Demographics
NPI:1639188857
Name:WANG, SHU H (MD)
Entity Type:Individual
Prefix:
First Name:SHU
Middle Name:H
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 1:550 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2114
Mailing Address - Country:US
Mailing Address - Phone:631-852-1000
Mailing Address - Fax:
Practice Address - Street 1:550 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2114
Practice Address - Country:US
Practice Address - Phone:631-852-1001
Practice Address - Fax:631-852-1122
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110139899OtherRR#
NY01769988Medicaid
110139899OtherRR#
G18769Medicare UPIN