Healthcare Provider Details

I. General information

NPI: 1598024507
Provider Name (Legal Business Name): JASON JON WU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BILBY RD STE 201
HACKETTSTOWN NJ
07840-4174
US

IV. Provider business mailing address

108 BILBY RD STE 201
HACKETTSTOWN NJ
07840-4174
US

V. Phone/Fax

Practice location:
  • Phone: 908-684-3005
  • Fax: 908-684-3301
Mailing address:
  • Phone: 908-684-3005
  • Fax: 908-684-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number266534-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MB09295900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB09295900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number266534-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: