Active NPI
Fabian Sergio Wander, L.M.S.W.
- Social Worker
- Woodside, NY
National Provider Identifier
1457518292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 075755
- Practice address
- 6714 41St Ave
Woodside Clinic
Woodside, NY 11377-3790 - Phone
- (917) 568-3500
- NPI assigned
- May 20, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 075755 | NY | Primary |
Addresses
Primary practice location
6714 41St Ave
Woodside Clinic
Woodside, NY 11377-3790
Mailing address
8309 35TH Ave
A-22
Jackson Heights, NY 11372-5370
Phone (917) 568-3500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 075755 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268611200000",
"number": "1457518292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8309 35TH AVE",
"address_2": "A-22",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113725370",
"telephone_number": "917-568-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6714 41ST AVE",
"address_2": "WOODSIDE CLINIC",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113773790",
"telephone_number": "917-568-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANDER",
"first_name": "FABIAN",
"middle_name": "SERGIO",
"name_prefix": "Mr.",
"credential": "L.M.S.W.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-20",
"last_updated": "2010-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "075755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.