Healthcare Provider Details

I. General information

NPI: 1548258692
Provider Name (Legal Business Name): HO-SHYUAN WU PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 E MAIN ST STE 411
SOMERVILLE NJ
08876-2319
US

IV. Provider business mailing address

5 SEDGEFIELD DR
MORRIS PLAINS NJ
07950-3032
US

V. Phone/Fax

Practice location:
  • Phone: 908-304-5953
  • Fax:
Mailing address:
  • Phone: 973-885-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00425700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35S100425700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: