Healthcare Provider Details

I. General information

NPI: 1043455868
Provider Name (Legal Business Name): JUNG F WU MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BROAD AVE SUITE 201
RIDGEFIELD NJ
07657-1697
US

IV. Provider business mailing address

15 S VIRGINIA CT
ENGLEWOOD CLIFFS NJ
07632-2117
US

V. Phone/Fax

Practice location:
  • Phone: 201-941-9117
  • Fax: 201-941-9107
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA03121700
License Number StateNJ

VIII. Authorized Official

Name: JUNG FAUG WU
Title or Position: SELF / OWNER
Credential: MD
Phone: 201-945-2481