Provider Demographics
NPI:1831169143
Name:WANG, ANNABEL
Entity type:Individual
Prefix:DR
First Name:ANNABEL
Middle Name:
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 1:5 EAST 98 ST
Mailing Address - Street 2:BOX 1139
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-7076
Mailing Address - Fax:212-860-4952
Practice Address - Street 1:5 EAST 98 ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-7076
Practice Address - Fax:212-860-4952
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2123242084N0400X
CAC526572084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7Y5221OtherEMPIRE BC BS
NY02007656Medicaid
NYG54039Medicare UPIN
NY02007656Medicaid