MEDICARE: DR. MEREDITH J. WONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	249589	NY

General Provider Information

NPI Number	:	1073773040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDITH J. WONG M.D.

Provider Business Mailing Address
First Line	:	5 W 86TH ST APT 6A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-3663
Country	:	US
Telephone Number	:	646-715-4642
Fax Number	:	646-607-9495

Provider Business Practice Location Address
First Line	:	5 W 86TH ST APT 6A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-3663
Country	:	US
Telephone Number	:	646-715-4642
Fax Number	:	646-607-9495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	03/07/2022

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