Healthcare Provider Details

I. General information

NPI: 1093213266
Provider Name (Legal Business Name): ADAM WANG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR STE 305
PARAMUS NJ
07652-3510
US

IV. Provider business mailing address

400 RIVERFRONT BLVD APT 406
ELMWOOD PARK NJ
07407-3610
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-5220
  • Fax:
Mailing address:
  • Phone: 856-651-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01766800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40QA01766800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: