Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | M5568 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA08379000 | NJ |
NPI | 1356402093 |
---|---|
Provider Name | Dr. Jian Wang |
First Address | Westfield, NJ 07090-3519 |
Second Address | Lyons, NJ 07019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 17/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186598202 | (05) | TX |
I71585 | (02) | TX |
K3204660 | (05) | TX |