Individual provider Active NPI

Yuejun Wang, AU.D

  • Audiologist
  • Watertown, NY
National Provider Identifier
1508472788
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Practice address
53-59 Public SQ Ste 202
Watertown, NY 13601-2674
Phone
(315) 786-3225
NPI assigned
Sep 22, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X
Audiologist 231H00000X Primary

Addresses

Primary practice location

53-59 Public SQ Ste 202
Watertown, NY 13601-2674

Mailing address

1005 1/2 W Sullivan St
Olean, NY 14760-2231
Phone (917) 923-3902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210422000308 NY Practitioner - Qualified Audiologist 8022426519 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002996NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
East Coast Audiology and Physical Therapy, PLLC Audiologist CurrentSince Jan 1, 2022 Accepting new patients
Audiology Distribution, LLC Audiologist-Hearing Aid Fitter CurrentSince Sep 6, 2023 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Mar 28, 2022 Accepting new patients
Western New York Medical Practice PC CurrentSince Mar 28, 2022 Accepting new patients

Locations

544 Towne Dr
Fayetteville, NY 13066
Phone (315) 637-8800

7232 Austin St
Forest Hills, NY 11375
Phone (718) 577-5121

800 Northern Blvd
Great Neck, NY 11021
Phone (516) 829-8450

800 Northern Blvd
Ste 3
Great Neck, NY 11021

1776 Broadway
New York, NY 10019
Phone (212) 399-7329

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

10 Hagen Dr
Ste 100
Rochester, NY 14625
Phone (585) 723-2813

53-59 Public Sq
Ste 202
Watertown, NY 13601
Phone (315) 786-3225

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1508472788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 1/2 W SULLIVAN ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147602231",
            "telephone_number": "917-923-3902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53-59 PUBLIC SQ STE 202",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012674",
            "telephone_number": "315-786-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "YUEJUN",
        "credential": "AU.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.