MEDICARE: JUDY WONG MD, MPH, CPH

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	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	208600000X	Surgery Physician	25MA12589400	NJ

General Provider Information

NPI Number	:	1831713924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY WONG MD, MPH, CPH

Provider Business Mailing Address
First Line	:	877 BAY RIDGE AVE APT L7
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5740
Country	:	US
Telephone Number	:	347-583-7453
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 BEACH 19TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4423
Country	:	US
Telephone Number	:	718-869-7360
Fax Number	:

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	01/05/2026

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