Provider Demographics
NPI:1366826786
Name:VINCENT WANG WELLNESS CENTER
Entity type:Organization
Organization Name:VINCENT WANG WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-886-3877
Mailing Address - Street 1:39-16 PRINCE STREET
Mailing Address - Street 2:STE 251
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-886-3877
Mailing Address - Fax:718-886-3995
Practice Address - Street 1:3916 PRINCE ST
Practice Address - Street 2:STE 251
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5361
Practice Address - Country:US
Practice Address - Phone:718-886-3877
Practice Address - Fax:718-886-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty