Provider Demographics
NPI:1659335941
Name:WUN, HERRICK (MD)
Entity Type:Individual
Prefix:
First Name:HERRICK
Middle Name:
Last Name:WUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WILLIAM ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2612
Mailing Address - Country:US
Mailing Address - Phone:212-312-5577
Mailing Address - Fax:212-312-5769
Practice Address - Street 1:156 WILLIAM ST FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5322
Practice Address - Country:US
Practice Address - Phone:212-312-5577
Practice Address - Fax:212-312-5769
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2142512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1N0571Medicare PIN