Healthcare Provider Details

I. General information

NPI: 1396895173
Provider Name (Legal Business Name): RAYMOND F WONG M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST SUITE PH105
NEW YORK NY
10013-4552
US

IV. Provider business mailing address

139 CENTRE ST SUITE PH105
NEW YORK NY
10013-4552
US

V. Phone/Fax

Practice location:
  • Phone: 212-227-5451
  • Fax:
Mailing address:
  • Phone: 212-227-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number183388
License Number StateNY

VIII. Authorized Official

Name: DR. RAYMOND F WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-227-5451