Provider Demographics
NPI:1427804673
Name:WAB GROUP CORPORATION
Entity type:Organization
Organization Name:WAB GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SELOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAB-LUMOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-206-2615
Mailing Address - Street 1:12 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1611
Mailing Address - Country:US
Mailing Address - Phone:646-206-2615
Mailing Address - Fax:
Practice Address - Street 1:12 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1611
Practice Address - Country:US
Practice Address - Phone:646-206-2615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage