Provider Demographics
NPI:1053473843
Name:HSU, WARREN WENJSAIR (DO)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:WENJSAIR
Last Name:HSU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212-15 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3519
Mailing Address - Country:US
Mailing Address - Phone:718-217-8600
Mailing Address - Fax:718-217-0926
Practice Address - Street 1:21215 UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3519
Practice Address - Country:US
Practice Address - Phone:718-217-8600
Practice Address - Fax:718-217-0926
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186109207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY186109OtherNY LICENSE #
NYG400001034OtherPTAN
NYG49412Medicare UPIN
NY07219Medicare ID - Type Unspecified