Provider Demographics
NPI:1073991444
Name:WU, JING JING
Entity Type:Individual
Prefix:
First Name:JING JING
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 REALITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405
Mailing Address - Country:US
Mailing Address - Phone:201-294-1164
Mailing Address - Fax:
Practice Address - Street 1:120 COUNTY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1854
Practice Address - Country:US
Practice Address - Phone:201-294-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00112200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist