Provider Demographics
NPI:1609862044
Name:WU, JASON JINGSHI (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JINGSHI
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2844
Practice Address - Country:US
Practice Address - Phone:718-283-7500
Practice Address - Fax:718-635-7235
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221606208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2099718OtherUNITED HEALTHCARE
NY3C2641OtherHEALTH NET
NY1000020644OtherAFFINITY HEALTH
NY3437169OtherAETNA USHC HMO
NYWJ1606OtherATLANTIS HEALTH
NY0101830-02OtherAMERICHOICE
NY221606OtherHIP
NY359010101OtherHEALTH PLUS
NY221606-B15OtherHEALTH FIRST
NY7537263OtherAETNA PPO
NYP2530534OtherOXFORD HEALTH
NY02174330Medicaid
NY221606OtherHIP
NY7537263OtherAETNA PPO