Provider Demographics
NPI:1053576207
Name:WANG, YIZE RICHARD (MD)
Entity type:Individual
Prefix:
First Name:YIZE
Middle Name:RICHARD
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:501 FELLOWSHIP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3419
Practice Address - Country:US
Practice Address - Phone:856-642-2133
Practice Address - Fax:856-642-2134
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09087900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001201800Medicaid
FLCC107ZMedicare PIN