Provider Demographics
NPI:1205051067
Name:WANG, THERESA LI-CHU (CNM)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LI-CHU
Last Name:WANG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:1037 MAIN ST
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2913
Practice Address - Country:US
Practice Address - Phone:914-734-8800
Practice Address - Fax:914-734-8771
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001108-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02823641Medicaid
NYA400048397Medicare PIN