Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1043455918 |
---|---|
Provider Name | Mr. William Caleb Wang |
First Address | Flushing, NY 11355 |
Second Address | Flushing, NY 11355-1050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2008 |
Last Update Date | 10/12/2008 |