Basic Information
| Provider Information | |||||||||
| NPI: | 1083870182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAO | ||||||||
| FirstName: | WEN-JENG | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | YAO | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4141 CARPENTER AVENUE | ||||||||
| Address2: | 3RD FLOOR, OPHTHALMOLOGY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10466 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4141 CARPENTER AVE | ||||||||
| Address2: | 3RD FLOOR, OPHTHALMOLOGY DEPARTMENT | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189202020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0009X | 256410-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | 207W00000X | 256410-1 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.