Healthcare Provider Details

I. General information

NPI: 1487640306
Provider Name (Legal Business Name): WILBUR WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax: 609-754-9249
Mailing address:
  • Phone: 866-377-2778
  • Fax: 609-754-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06471400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number25MA06471400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: