Healthcare Provider Details

I. General information

NPI: 1972967669
Provider Name (Legal Business Name): ABBY WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MONTAUK AVENUE DEPARTMENT OF SURGERY
NEW LONDON CT
06320
US

IV. Provider business mailing address

365 MONTAUK AVE DEPARTMENT OF SURGERY
NEW LONDON CT
06320
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-3147
  • Fax:
Mailing address:
  • Phone: 860-443-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number75836
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: