Provider Demographics
NPI:1669507588
Name:WANG, GEORGE C (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-0586
Mailing Address - Country:US
Mailing Address - Phone:973-671-1868
Mailing Address - Fax:973-358-6594
Practice Address - Street 1:16 POCONO RD STE 304
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2908
Practice Address - Country:US
Practice Address - Phone:973-671-1868
Practice Address - Fax:973-671-1869
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07658700207R00000X, 207RG0300X
MDD67789207RG0300X
NY282598207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018557400Medicaid
MD130519ZADOMedicare PIN