Provider Demographics
NPI:1053392514
Name:MAK, WANG Y (MD)
Entity type:Individual
Prefix:
First Name:WANG
Middle Name:Y
Last Name:MAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1060
Mailing Address - Country:US
Mailing Address - Phone:914-574-5720
Mailing Address - Fax:914-574-5723
Practice Address - Street 1:455 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1060
Practice Address - Country:US
Practice Address - Phone:914-574-5720
Practice Address - Fax:914-574-5723
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2313521207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02667494Medicaid
A400015932Medicare PIN
I61684Medicare UPIN