Healthcare Provider Details

I. General information

NPI: 1851011340
Provider Name (Legal Business Name): BRUNSWICK DIAGNOSTICS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

PO BOX 541
MONMOUTH JUNCTION NJ
08852-0541
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8534
  • Fax: 732-220-8595
Mailing address:
  • Phone: 732-266-3409
  • Fax: 732-220-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HONGLING WANG
Title or Position: PRESIDENT
Credential: MD
Phone: 732-266-3409