Healthcare Provider Details

I. General information

NPI: 1144893777
Provider Name (Legal Business Name): JUSTIN WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7491
US

IV. Provider business mailing address

1 EUCLID RD
FORT LEE NJ
07024-6406
US

V. Phone/Fax

Practice location:
  • Phone: 844-692-4692
  • Fax:
Mailing address:
  • Phone: 929-624-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number341610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: