Healthcare Provider Details

I. General information

NPI: 1245475581
Provider Name (Legal Business Name): DAVID TOM WONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5814
  • Fax:
Mailing address:
  • Phone: 718-518-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: