Provider Demographics
NPI:1255406443
Name:WU, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PATERSON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2109
Mailing Address - Country:US
Mailing Address - Phone:732-258-0061
Mailing Address - Fax:732-993-9497
Practice Address - Street 1:90 PATERSON ST
Practice Address - Street 2:STE 100
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2109
Practice Address - Country:US
Practice Address - Phone:201-996-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076726002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00088826OtherRR MCR PTAN
NJ0014729Medicaid
NJ0014729Medicaid
NJ076667A0XMedicare PIN