Basic Information
Provider Information
NPI: 1881993624
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WANG
FirstName: KATHERINE
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 GUSTAVE L LEVY PL # 3000
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296504
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1 GUSTAVE L LEVY PL
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296504
CountryCode: US
TelephoneNumber: 2122415561
FaxNumber: 2128609737
Other Information
ProviderEnumerationDate: 03/18/2011
LastUpdateDate: 02/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X269780NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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