Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 216631-1 | NY |
NPI | 1053382051 |
---|---|
Provider Name | Gary Wang |
First Address | Buffalo, NY 14214-2693 |
Second Address | Buffalo, NY 14214-2693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 18/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02119762 | (05) | NY |
H28852 | (02) | NY |