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Individual

SAN SAN WYNN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
56 HAMILTON DR, ROSLYN, NY 11576-3129
(718) 498-5754
(718) 498-0950
Mailing address
723 E 87TH ST, BROOKLYN, NY 11236-3620
(718) 498-5754
(718) 498-0950

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
220806
NY
207RH0003X
Hematology & Oncology Physician
Primary
220806
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01864988
NY
Enumeration date
02/08/2006
Last updated
04/09/2014
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