Provider Demographics
NPI:1205905593
Name:WU, JOSEPHINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27005 76TH AVE
Mailing Address - Street 2:LIJMC
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1433
Mailing Address - Country:US
Mailing Address - Phone:718-470-7917
Mailing Address - Fax:718-347-3483
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:LIJMC
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1433
Practice Address - Country:US
Practice Address - Phone:718-470-7917
Practice Address - Fax:718-347-3483
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048116-11223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02373673Medicaid
NY05633Medicare ID - Type Unspecified
NY02373673Medicaid