Provider Demographics
NPI:1053018374
Name:AIJUAN WANG MEDICINE PLLC
Entity type:Organization
Organization Name:AIJUAN WANG MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHEEV
Authorized Official - Suffix:
Authorized Official - Credentials:HR
Authorized Official - Phone:718-350-5680
Mailing Address - Street 1:2 LINCOLN HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3618
Practice Address - Country:US
Practice Address - Phone:833-424-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care