Provider Demographics
NPI:1770886921
Name:DR. DA WANG PSYCHIATRIC CONSULTATION, P.C.
Entity type:Organization
Organization Name:DR. DA WANG PSYCHIATRIC CONSULTATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-581-9835
Mailing Address - Street 1:11 WILLETS DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3913
Mailing Address - Country:US
Mailing Address - Phone:516-581-9835
Mailing Address - Fax:
Practice Address - Street 1:13336 41ST RD STE 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3661
Practice Address - Country:US
Practice Address - Phone:516-581-9835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256826261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health