MEDICARE: JACK C. WU, M.D. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	25MA298330	NJ
2	207Q00000X	Family Medicine Physician	25MB07468500	NJ

General Provider Information

NPI Number	:	1396843777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK C. WU, M.D. P.A.

Provider Business Mailing Address
First Line	:	219 HIGHLAND AVE
Second Line	:
City	:	WESTVILLE
State	:	NJ
Zip	:	08093-1014
Country	:	US
Telephone Number	:	856-456-1881
Fax Number	:	856-456-3959

Provider Business Practice Location Address
First Line	:	219 HIGHLAND AVE
Second Line	:
City	:	WESTVILLE
State	:	NJ
Zip	:	08093-1014
Country	:	US
Telephone Number	:	856-456-1881
Fax Number	:	856-456-3959

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN WU
Credential	:	DO
Telephone Number	:	856-456-1881

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/14/2022

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