Provider Demographics
NPI:1265687347
Name:WU, JIANLIN (MD)
Entity Type:Individual
Prefix:
First Name:JIANLIN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 58TH STREET, 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3679
Mailing Address - Country:US
Mailing Address - Phone:347-770-8009
Mailing Address - Fax:347-770-8011
Practice Address - Street 1:839 58TH STREET, 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3679
Practice Address - Country:US
Practice Address - Phone:347-770-8009
Practice Address - Fax:347-770-8011
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY253945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03142376Medicaid