Provider Demographics
NPI:1245406172
Name:DAI, WANJU SHAW (MD)
Entity Type:Individual
Prefix:DR
First Name:WANJU
Middle Name:SHAW
Last Name:DAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 KOCIEMBA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-5531
Mailing Address - Country:US
Mailing Address - Phone:201-383-0263
Mailing Address - Fax:
Practice Address - Street 1:235 KOCIEMBA DR
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-5531
Practice Address - Country:US
Practice Address - Phone:201-383-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA504752083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine