Lisa Jue Wang

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

299261 Issued in NY

Practice address

21 Deer LN
East Setauket, NY 11733-3406

Phone

(631) 413-5430

NPI assigned

Mar 24, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1285096552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 DEER LN",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333406",
            "telephone_number": "631-413-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 DEER LN",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333406",
            "telephone_number": "631-413-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "LISA",
        "middle_name": "JUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-24",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "299261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelly Beth Waldman, M.D.
• Walgreen Co
• David Wallach, M.D.
• Wayne Waltzer, M.D.
• Edward Wang, M.D.
• Nicole Rachel Ward, CASAC-T
• Nicole Jennifer Washington, M.S. CCC-SLP
• Michael Raymond Weber, MD
• Nancy E Weiner, RN
• Jody Weiss-Burns, MS

• Family Medicine Physician in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.