Healthcare Provider Details

I. General information

NPI: 1205218682
Provider Name (Legal Business Name): RUI WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORRESTAL RD S STE 205
PRINCETON NJ
08540-6666
US

IV. Provider business mailing address

10 FORRESTAL RD S STE 205
PRINCETON NJ
08540-6666
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-2230
  • Fax: 609-924-5006
Mailing address:
  • Phone: 609-924-2230
  • Fax: 609-924-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA11535500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA11535500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: