Provider Demographics
NPI:1831191550
Name:WU, YAN (MD)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CAPITAL WAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-303-4300
Mailing Address - Fax:609-303-4301
Practice Address - Street 1:2 CAPITAL WAY
Practice Address - Street 2:SUITE 290
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-303-4300
Practice Address - Fax:609-303-4301
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226357-1207R00000X, 207RE0101X
NJ25MA07545200207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3597667OtherOXFORD
NJ1490025OtherAMERIHEALTH PPO
NJ2379037OtherUNITED HEALTHCARE
NJ38777OtherUNIVERSITY HEALTH PLAN
NJP00219331OtherRR MEDICARE
NJ2179718000OtherAMERIHEALTH/KEYSTONE/IBC
NJ0019127Medicaid
NJ3K6072OtherHEALTHNET, INC
NJ1490025OtherAMERIHEALTH PPO
NJP3597667OtherOXFORD