Healthcare Provider Details

I. General information

NPI: 1306835327
Provider Name (Legal Business Name): SHIRLEY W TSONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WHITE RD SUITE 209
LITTLE SILVER NJ
07739-1166
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-0673
  • Fax: 732-842-7352
Mailing address:
  • Phone: 856-669-6050
  • Fax: 732-842-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA06946800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: