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NPI Code Detail

MEDICARE: JACK WANG

MEDICARE: JACK WANG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA02232900NJ

General Provider Information

NPI Number : 1336091222
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK WANG
Provider Business Mailing Address
First Line : PO BOX 52402
Second Line :
City : PHOENIX
State : AZ
Zip : 85072-2402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 NARDONE PL
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07306-3514
Country : US
Telephone Number : 201-792-3840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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