| Le-ben Wan Md Phd Pc | |
|
4402 23rd St Ste 504 Long Island City NY 11101-5072 | |
| (929) 322-4236 | |
| Not Available |
| Full Name | Le-ben Wan Md Phd Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4402 23rd St Ste 504, Long Island City, New York |
| Authorized Official Name and Position | Le-ben Wan (PRESIDENT) |
| Authorized Official Contact | 9293224236 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Le-ben Wan Md Phd Pc 4402 23rd St Ste 504 Long Island City NY 11101-5072 Ph: () - | Le-ben Wan Md Phd Pc 4402 23rd St Ste 504 Long Island City NY 11101-5072 Ph: (929) 322-4236 |
| NPI Number | 1750808051 |
|---|---|
| Provider Enumeration Date | 08/28/2017 |
| Last Update Date | 12/24/2017 |
| Medicare PECOS PAC ID | 1658609730 |
|---|---|
| Medicare Enrollment ID | O20190828000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750808051 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 261874 (New York) | Primary |
| Provider Name | Le-ben Wan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356665954 PECOS PAC ID: 2567790645 Enrollment ID: I20190828000158 |
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