Healthcare Provider Details

I. General information

NPI: 1780474965
Provider Name (Legal Business Name): WEELIC CHONG MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE # 93
VINELAND NJ
08360-7059
US

IV. Provider business mailing address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-6092
  • Fax:
Mailing address:
  • Phone: 856-641-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMT233526
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: