Provider Demographics
NPI:1023327939
Name:WANG, SU-LAN (LAC)
Entity type:Individual
Prefix:
First Name:SU-LAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KEVIN RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4258
Mailing Address - Country:US
Mailing Address - Phone:732-738-1115
Mailing Address - Fax:732-738-4445
Practice Address - Street 1:786 KING GEORGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1981
Practice Address - Country:US
Practice Address - Phone:732-738-1115
Practice Address - Fax:732-738-4445
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00069500171100000X
NY6637713171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist