Healthcare Provider Details

I. General information

NPI: 1457204513
Provider Name (Legal Business Name): WILSON HUANG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W CUTHBERT BLVD UNIT 26 SUITE A
WESTMONT NJ
08108
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-946-5180
  • Fax: 856-946-5181
Mailing address:
  • Phone: 856-946-5180
  • Fax: 856-946-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15528500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ15528500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: