Healthcare Provider Details

I. General information

NPI: 1710366232
Provider Name (Legal Business Name): ANDREW WONG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE BLDG 1200, 2ND FL
EGG HARBOR TOWNSHIP NJ
08234
US

IV. Provider business mailing address

1671 CROOKED OAK DR
LANCASTER PA
17601-4269
US

V. Phone/Fax

Practice location:
  • Phone: 609-833-9833
  • Fax:
Mailing address:
  • Phone: 717-569-5331
  • Fax: 717-569-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS020693
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MB11971600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: