Healthcare Provider Details

I. General information

NPI: 1073586327
Provider Name (Legal Business Name): DANNY FONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CANAL ST
NEW YORK NY
10013-3501
US

IV. Provider business mailing address

254 CANAL ST SUITE 5001
NEW YORK NY
10013-3501
US

V. Phone/Fax

Practice location:
  • Phone: 212-343-9009
  • Fax: 212-431-4856
Mailing address:
  • Phone: 212-343-9009
  • Fax: 212-431-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number171165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: