1952428732 NPI number — WAYNE WINGCHIN LI P.T.

Table of content: WAYNE WINGCHIN LI P.T. (NPI 1952428732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952428732 NPI number — WAYNE WINGCHIN LI P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
WAYNE
Provider Middle Name:
WINGCHIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952428732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22159 HORACE HARDING EXPY FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND GARDENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11364-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-951-3953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 BOWERY STREET
Provider Second Line Business Practice Location Address:
6 FL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-4615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-219-9197
Provider Business Practice Location Address Fax Number:
718-569-0578
Provider Enumeration Date:
03/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  023663-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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