Provider Demographics
NPI:1972537314
Name:TAO, WENJING (MD)
Entity Type:Individual
Prefix:
First Name:WENJING
Middle Name:
Last Name:TAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13620 38TH AVE
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4277
Mailing Address - Country:US
Mailing Address - Phone:718-886-8807
Mailing Address - Fax:718-886-8863
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:SUITE 6B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4277
Practice Address - Country:US
Practice Address - Phone:718-886-8807
Practice Address - Fax:718-886-8863
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218105208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02152514Medicaid
NY02152514Medicaid
NY5330TP / 0026PAMedicare UPIN