Healthcare Provider Details

I. General information

NPI: 1558710947
Provider Name (Legal Business Name): DANIEL G WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 SAW MILL RIVER RD STE 3C6
ARDSLEY NY
10502-2157
US

IV. Provider business mailing address

545 SAW MILL RIVER RD # 3C6
ARDSLEY NY
10502-2157
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-6185
  • Fax: 914-216-7101
Mailing address:
  • Phone: 914-594-6185
  • Fax: 914-216-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61972
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number305312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: