Healthcare Provider Details

I. General information

NPI: 1700325610
Provider Name (Legal Business Name): COMPREHENSIVE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LINCOLN HWY STE 500
EDISON NJ
08820-3904
US

IV. Provider business mailing address

2 LINCOLN HWY STE 500
EDISON NJ
08820-3904
US

V. Phone/Fax

Practice location:
  • Phone: 732-516-9868
  • Fax: 732-516-9869
Mailing address:
  • Phone: 732-516-9868
  • Fax: 732-516-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AIJUAN WANG
Title or Position: PHYSICIAN
Credential: MD
Phone: 731-221-6870