Healthcare Provider Details

I. General information

NPI: 1376958660
Provider Name (Legal Business Name): CECILIA QIANWEN DONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 BROADWAY FL 2
BROOKLYN NY
11206-5316
US

IV. Provider business mailing address

7409 37TH AVE STE 303
JACKSON HEIGHTS NY
11372-6303
US

V. Phone/Fax

Practice location:
  • Phone: 888-212-3937
  • Fax:
Mailing address:
  • Phone: 888-212-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number300727
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number156666
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number300727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: