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NPI Code Detail

MEDICARE: DR. SERENA T WONG MD

MEDICARE: DR. SERENA T WONG 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
1207R00000XInternal Medicine Physician25MA07741300NJ
2208D00000XGeneral Practice Physician25MA07741300NJ

Other Identifiers

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

General Provider Information

NPI Number : 1881689511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SERENA T WONG MD
Provider Business Mailing Address
First Line : 195 LITTLE ALBANY ST
Second Line :
City : NEW BRUNSWICK
State : NJ
Zip : 08901-1914
Country : US
Telephone Number : 908-295-2172
Fax Number :
Provider Business Practice Location Address
First Line : 195 LITTLE ALBANY ST
Second Line :
City : NEW BRUNSWICK
State : NJ
Zip : 08901-1914
Country : US
Telephone Number : 908-295-2172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 09/06/2016

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