Healthcare Provider Details

I. General information

NPI: 1992141980
Provider Name (Legal Business Name): RAYMOND FONG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 38TH AVE SUITE 6H
FLUSHING NY
11354-4277
US

IV. Provider business mailing address

13620 38TH AVE SUITE 6H
FLUSHING NY
11354-4277
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-3790
  • Fax: 718-762-0138
Mailing address:
  • Phone: 718-762-3790
  • Fax: 718-762-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number150422
License Number StateNY

VIII. Authorized Official

Name: DR. RAYMOND FONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-762-3790