Healthcare Provider Details

I. General information

NPI: 1073508701
Provider Name (Legal Business Name): SOMAN MARY WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/13/2026
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST STE 809
NEW YORK NY
10013-4558
US

IV. Provider business mailing address

139 CENTRE ST STE 809
NEW YORK NY
10013-4558
US

V. Phone/Fax

Practice location:
  • Phone: 212-349-5555
  • Fax: 212-791-9598
Mailing address:
  • Phone: 212-349-5555
  • Fax: 212-791-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number191580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: