MEDICARE: SPRINGSEA MEDICAL LLC

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
1	207R00000X	Internal Medicine Physician	253945	NY

General Provider Information

NPI Number	:	1780918516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGSEA MEDICAL LLC

Provider Business Mailing Address
First Line	:	142 ASHBROOK RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-3820
Country	:	US
Telephone Number	:	856-795-6272
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4211
Country	:	US
Telephone Number	:	718-680-8881
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JIANLIN WU
Credential	:	M.D.
Telephone Number	:	856-795-6272

Provider Enumeration Date	:	09/26/2009
Last Update Date	:	09/26/2009

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