Provider Demographics
NPI:1457563645
Name:MARIA L WING MD P.C.
Entity Type:Organization
Organization Name:MARIA L WING MD P.C.
Other - Org Name:NORTHRIDGE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WING
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:914-235-8224
Mailing Address - Street 1:1333A NORTH AVE PMB 436
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:914-235-8224
Mailing Address - Fax:914-235-6940
Practice Address - Street 1:77 QUAKER RIDGE RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804
Practice Address - Country:US
Practice Address - Phone:914-235-8224
Practice Address - Fax:914-235-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161772174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01060631Medicaid
NY19E651Medicare ID - Type Unspecified
NY01060631Medicaid