Provider Demographics
NPI:1265945158
Name:JONATHAN WANG PHYSICAL THERAPY SERVICE PC
Entity type:Organization
Organization Name:JONATHAN WANG PHYSICAL THERAPY SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-683-5653
Mailing Address - Street 1:84 WILLOW AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4278
Mailing Address - Country:US
Mailing Address - Phone:732-333-3200
Mailing Address - Fax:732-333-3229
Practice Address - Street 1:84 WILLOW AVE FL 1
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4278
Practice Address - Country:US
Practice Address - Phone:732-333-3200
Practice Address - Fax:732-333-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01753100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy