Provider Demographics
NPI:1841592433
Name:JONATHAN WANG DO LLC
Entity Type:Organization
Organization Name:JONATHAN WANG DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-285-1999
Mailing Address - Street 1:290 MADISON AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7400
Mailing Address - Country:US
Mailing Address - Phone:973-285-1999
Mailing Address - Fax:973-359-8979
Practice Address - Street 1:290 MADISON AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7400
Practice Address - Country:US
Practice Address - Phone:973-285-1999
Practice Address - Fax:973-359-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05714800261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF20555Medicare UPIN