Basic Information
| Provider Information | |||||||||
| NPI: | 1497113047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOHLBERG | ||||||||
| FirstName: | YING | ||||||||
| MiddleName: | LIU | ||||||||
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| OtherLastName: | LIU | ||||||||
| OtherFirstName: | YING | ||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3332 WALDEN AVE | ||||||||
| Address2: | STE 110 | ||||||||
| City: | DEPEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140432400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166687051 | ||||||||
| FaxNumber: | 7166687069 | ||||||||
| Practice Location | |||||||||
| Address1: | 656 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168830515 | ||||||||
| FaxNumber: | 7168838764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2016 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP130245 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LA2200X | F307799-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.