Healthcare Provider Details

I. General information

NPI: 1053497156
Provider Name (Legal Business Name): MARTHA SHIH WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. YA-MEI SHIH

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 GRAND CONCOURSE SUITE 1C
BRONX NY
10451-2814
US

IV. Provider business mailing address

127 BREWSTER RD
SCARSDALE NY
10583-2003
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-7384
  • Fax: 718-665-5335
Mailing address:
  • Phone: 718-665-7384
  • Fax: 718-665-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number113881
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number113881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: