Provider Demographics
NPI:1336663343
Name:Q. T. WANG, MD. NEUROLOGY PC
Entity Type:Organization
Organization Name:Q. T. WANG, MD. NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QINGLIANG
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:410-227-1708
Mailing Address - Street 1:3 GATE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1012
Mailing Address - Country:US
Mailing Address - Phone:410-227-1708
Mailing Address - Fax:
Practice Address - Street 1:SKYVIEW MEDICAL CENTER, SUITE E-08
Practice Address - Street 2:131-07 40TH RD
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:410-227-1708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2523212084D0003X, 2084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03295383Medicaid