Provider Demographics
NPI:1225143134
Name:WANG, YUE (MD)
Entity Type:Individual
Prefix:
First Name:YUE
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2065 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3414
Mailing Address - Country:US
Mailing Address - Phone:609-586-1001
Mailing Address - Fax:609-586-7634
Practice Address - Street 1:2065 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3414
Practice Address - Country:US
Practice Address - Phone:609-586-1001
Practice Address - Fax:609-586-7634
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07292700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ108690OtherPTAN
NJ8638608Medicaid
NJ051185V9UMedicare PIN
NJ8638608Medicaid