Basic Information
| Provider Information | |||||||||
| NPI: | 1154664803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | LINDA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E 42ND ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100175699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466058186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 E 102ND ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100295204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126598551 | ||||||||
| FaxNumber: | 2128318116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 284463 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 284463 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.