MEDICARE: PACITA D ONG MD

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	207R00000X	Internal Medicine Physician	125211	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366536617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PACITA D ONG MD

Provider Business Mailing Address
First Line	:	123 FOREST HILL RD
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-3907
Country	:	US
Telephone Number	:	973-736-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 FRANKLIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3501
Country	:	US
Telephone Number	:	718-503-7700
Fax Number	:	718-503-7741

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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