Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 179469 | NY |
NPI | 1477623510 |
---|---|
Provider Name | Gene-Jack Wang |
First Address | Glen Cove, NY 11542 |
Second Address | Glen Cove, NY 11542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |