Provider Demographics
NPI:1356963227
Name:WANG, ELIZABETH ING-JIE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ING-JIE
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E 45TH ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3409
Mailing Address - Country:US
Mailing Address - Phone:619-920-8008
Mailing Address - Fax:
Practice Address - Street 1:2739 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5801
Practice Address - Country:US
Practice Address - Phone:718-838-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program