Basic Information
| Provider Information | |||||||||
| NPI: | 1174664643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LNW MEDICAL OFFICE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13604 NORTHERN BLVD STE CU3 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113546515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185786718 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 WALT WHITMAN RD STE 100A | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117463631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183217558 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | LIANG | ||||||||
| AuthorizedOfficialFirstName: | WEINING | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7183211552 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170100000X | 203586 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics |
ID Information
| ID | Type | State | Issuer | Description | 01849985 | 05 | NY | MEDICAID |