Provider Demographics
NPI:1467580142
Name:WANG, JONATHAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:182 SOUTH ST STE 2
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5350
Practice Address - Country:US
Practice Address - Phone:973-539-2468
Practice Address - Fax:973-285-3835
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05714800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF20555Medicare UPIN
NJ015146Medicare ID - Type UnspecifiedEMPIRE MEDICARE