Healthcare Provider Details

I. General information

NPI: 1568977585
Provider Name (Legal Business Name): DAVID JACOB WONG PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HUTCHINSON RIVER PKWY
BRONX NY
10465-1887
US

IV. Provider business mailing address

1529 STADIUM AVE
BRONX NY
10465-1115
US

V. Phone/Fax

Practice location:
  • Phone: 347-991-7782
  • Fax:
Mailing address:
  • Phone: 347-556-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01768200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number048026
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: