Provider Demographics
NPI:1366609430
Name:WANG, GERALD JEH (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JEH
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:56-45 MAIN STREET
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-303-3720
Mailing Address - Fax:718-939-1167
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:718-939-1167
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2015-12-03
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Provider Licenses
StateLicense IDTaxonomies
NY235036208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03166878Medicaid
NYG4000020682Medicare PIN