MEDICARE: ADVANCED GASTROENTEROLOGY PRACTICE PLLC

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	207RG0100X	Gastroenterology Physician	223587	NY

General Provider Information

NPI Number	:	1184921728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED GASTROENTEROLOGY PRACTICE PLLC

Provider Business Mailing Address
First Line	:	77 BOWERY
Second Line	:	#701
City	:	NEW YORK
State	:	NY
Zip	:	10002-4915
Country	:	US
Telephone Number	:	212-775-8388
Fax Number	:	212-775-8383

Provider Business Practice Location Address
First Line	:	77 BOWERY
Second Line	:	#701
City	:	NEW YORK
State	:	NY
Zip	:	10002-4915
Country	:	US
Telephone Number	:	212-775-8388
Fax Number	:	212-775-8383

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY WONG
Credential	:	M.D.
Telephone Number	:	917-535-7908

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	03/18/2026

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