Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2313521 | NY |
NPI | 1053392514 |
---|---|
Provider Name | Wang Y Mak |
First Address | Scarsdale, NY 10583-1060 |
Second Address | Scarsdale, NY 10583-1060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 10/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02667494 | (05) | NY |
I61684 | (02) |