Provider Demographics
NPI:1396729026
Name:DR JENNIFER S WU PC
Entity type:Organization
Organization Name:DR JENNIFER S WU PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-665-1985
Mailing Address - Street 1:663 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3139
Mailing Address - Country:US
Mailing Address - Phone:781-665-1985
Mailing Address - Fax:781-665-0226
Practice Address - Street 1:663 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3139
Practice Address - Country:US
Practice Address - Phone:781-665-1985
Practice Address - Fax:781-665-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
130752OtherPILGRIM
MA9780599Medicaid
M16657OtherBLUE CROSS
M20661Medicare ID - Type Unspecified