National Provider Identifier
Elisa Marie Crystal Wang, MD
Elisa Marie Crystal Wang, MD is listed in the NPPES registry with a primary specialty of Psychiatry Physician in Ithaca, NY and a listed phone number of (607) 274-6200.
Profile Overview
- NPI
- 1942615646
- Provider Type
- Individual
- Primary Specialty
- Psychiatry Physician
- Enumeration Date
- June 23, 2014
- Last Updated
- May 13, 2024
Practice Location
- 201 E Green St
- Ithaca, NY 14850-5635
Phone: (607) 274-6200
Specialties
- Psychiatry Physician (2084P0800X)
- Psychiatry Physician (2084P0800X)
Full Record
- NPI
- 1942615646
- Entity Type
- Individual
- Last Name
- Wang
- First Name
- Elisa
- Middle Name
- Marie Crystal
- Name Prefix
- Dr.
- Credential
- MD
- Provider Other Last Name
- Crystal
- Provider Other First Name
- Elisa
- Provider Other Middle Name
- Marie
- Provider Other Name Prefix Text
- Dr.
- Provider Other Credential Text
- MD
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 201 E Green St
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-5635
- Mailing Country
- US
- Mailing Phone
- (607) 274-6200
- Practice Street Address
- 201 E Green St
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-5635
- Practice Country
- US
- Practice Phone
- (607) 274-6200
- Enumeration Date
- June 23, 2014
- Last Updated
- May 13, 2024
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- May 13, 2024
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Psychiatry Physician (2084P0800X), Psychiatry Physician (2084P0800X)