Provider Demographics
NPI:1154529667
Name:DR SHIH WANG PHYSICIAN PC
Entity type:Organization
Organization Name:DR SHIH WANG PHYSICIAN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIH
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-565-4110
Mailing Address - Street 1:199 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1536
Mailing Address - Country:US
Mailing Address - Phone:516-565-4110
Mailing Address - Fax:516-565-3313
Practice Address - Street 1:199 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1536
Practice Address - Country:US
Practice Address - Phone:516-565-4110
Practice Address - Fax:516-565-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149936207Q00000X
NY215157207Q00000X
NY246635207Q00000X
NY221486207Q00000X
NY244755207R00000X
NY211410207R00000X
NY213149208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty