Healthcare Provider Details

I. General information

NPI: 1578268793
Provider Name (Legal Business Name): JOFFRE ANDRES WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 10/04/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON 5TH FLOOR
BRONX NY
10456
US

IV. Provider business mailing address

1276 FULTON 5TH FLOOR
BRONX NY
10456
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8653
  • Fax: 718-901-8656
Mailing address:
  • Phone: 718-901-8653
  • Fax: 718-901-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: