Healthcare Provider Details

I. General information

NPI: 1982614830
Provider Name (Legal Business Name): BIENVENIDO S ONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 WILMINGTON RD
NEW CASTLE PA
16105
US

IV. Provider business mailing address

PO BOX 5100
NEW CASTLE PA
16105-0100
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-9001
  • Fax:
Mailing address:
  • Phone: 330-758-2775
  • Fax: 330-758-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD-034213-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: