Individual
WICHAE IM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7901 BROADWAY, ROOM A1-9, ELMHURST, NY 11373-1329
(718) 334-4952
(718) 334-4815
Mailing address
7901 BROADWAY, ROOM A1-9, ELMHURST, NY 11373-1329
(718) 344-2600
(718) 344-2623
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
198358
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01862922
—
NY
Enumeration date
06/27/2006
Last updated
12/10/2007
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