Provider Demographics
NPI:1730538596
Name:WU, BENEDICT CHANG (DO/PHD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:CHANG
Last Name:WU
Suffix:
Gender:M
Credentials:DO/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 WAYNE AVE FL 2D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2535
Mailing Address - Country:US
Mailing Address - Phone:718-920-8493
Mailing Address - Fax:
Practice Address - Street 1:3514 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1402
Practice Address - Country:US
Practice Address - Phone:718-920-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW000-063-82-386-0207N00000X
PAOT017295207R00000X
NY308444-01207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHS000293LOtherEMPLOYEE NUMBER