Individual
MRS. MIMI WANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, RD, C DN
Contact information
Practice address
800 POLY PL, BROOKLYN, NY 11209-7104
(718) 442-7303
Mailing address
63 RAVENHURST AVE, STATEN ISLAND, NY 10310-2631
(718) 442-7303
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
386601
NY
Other
Enumeration date
02/05/2008
Last updated
02/05/2008
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