Provider Demographics
NPI:1386700672
Name:WANG, PHILIP S (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:WANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:13235 41ST RD
Mailing Address - Street 2:APT 2D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4115
Mailing Address - Country:US
Mailing Address - Phone:718-461-5900
Mailing Address - Fax:718-461-4833
Practice Address - Street 1:13235 41ST RD
Practice Address - Street 2:APT 2D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4115
Practice Address - Country:US
Practice Address - Phone:718-461-5900
Practice Address - Fax:718-461-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX009628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04509Medicare ID - Type Unspecified