MEDICARE: DR. WINSTON L WONG DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	004956	NY

General Provider Information

NPI Number	:	1245362037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINSTON L WONG DPM

Provider Business Mailing Address
First Line	:	225 W 35TH ST
Second Line	:	2ND FL
City	:	NEW YORK
State	:	NY
Zip	:	10001-1904
Country	:	US
Telephone Number	:	212-971-0010
Fax Number	:	212-695-1865

Provider Business Practice Location Address
First Line	:	225 W 35TH ST
Second Line	:	2ND FL
City	:	NEW YORK
State	:	NY
Zip	:	10001-1904
Country	:	US
Telephone Number	:	212-971-0010
Fax Number	:	212-695-1865

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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