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Organization
WISTERIA MEDICAL CARE, PC
Active
Organization
WISTERIA MEDICAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENSON M. WU M.D. (PRESIDENT)
(718) 353-2121
Entity
Organization
Contact information
Practice address
136-30 MAPLE AVENUE, SUITE #2I, FLUSHING, QUEENS, NY 11355-3865
(718) 353-2121
(718) 353-7621
Mailing address
136-30 MAPLE AVENUE, SUITE #2I, FLUSHING, QUEENS, NY 11355-3865
(718) 353-2121
(718) 353-7621
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
203178
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04661756
—
NY
Enumeration date
06/18/2009
Last updated
06/18/2009
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