Healthcare Provider Details

I. General information

NPI: 1942293881
Provider Name (Legal Business Name): STEPHEN WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE FL 5
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 416457 MORRISTOWN NJ 07960
BOSTON MA
02241-2520
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-4990
  • Fax: 908-522-4988
Mailing address:
  • Phone: 844-362-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD423879
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA08582700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number25MA08582700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: