OrganizationGreat Wall Medical PcInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address14627 Beech Ave # 1c, Flushing, NY 11355-2172(718) 321-3962PECOS EnrollmentBased on the most recent information from CMS, provider Great Wall Medical Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1417250168Provider TypeOrganizationFull NameGreat Wall Medical PcSubpartNoEnumeration Date12/17/2010Last Updated12/17/2010Contact InformationPractice LocationPractice Address14627 Beech Ave # 1c, Flushing, NY 11355-2172Phone(718) 321-3962Fax(718) 321-3965Mailing LocationMailing Address14627 Beech Ave # 1c, Flushing, NY 11355-2172Phone(718) 321-3962Fax(718) 321-3965Authorized OfficialNameJang, Hangjun (Attending Physician)Phone(718) 321-3962Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense251295New York