Healthcare Provider Details

I. General information

NPI: 1104025170
Provider Name (Legal Business Name): WUN-YE JIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ELM ST
HARRINGTON PARK NJ
07640-1902
US

IV. Provider business mailing address

19 S WASHINGTON AVE
BERGENFIELD NJ
07621-2324
US

V. Phone/Fax

Practice location:
  • Phone: 201-784-0123
  • Fax: 201-784-0065
Mailing address:
  • Phone: 201-387-0177
  • Fax: 201-387-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07810800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: