Provider Demographics
NPI:1306901848
Name:WU, NAN T (MD)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:T
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 1:100 SHREWSBURY DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3404
Mailing Address - Country:US
Mailing Address - Phone:973-994-5130
Mailing Address - Fax:
Practice Address - Street 1:GREYSTONE PARK PSYCHIATRIC HOSPITAL
Practice Address - Street 2:1 CENTRAL AVENUE
Practice Address - City:GREYSTONE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-538-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02689400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57774Medicare UPIN
NJWU099043Medicare ID - Type Unspecified