Healthcare Provider Details

I. General information

NPI: 1205905593
Provider Name (Legal Business Name): JOSEPHINE WU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE LIJMC
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

27005 76TH AVE LIJMC
NEW HYDE PARK NY
11040-1433
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7917
  • Fax: 718-347-3483
Mailing address:
  • Phone: 718-470-7917
  • Fax: 718-347-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number048116-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: