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General NPI Number Information
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NPI Number | 1033559745
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Entity Type | Individual
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Provider Name | JIYUN WONG O.D
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Gender | Female
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 44 SYLVAN AVE STE 1B
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2417
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Country | US
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Telephone | 201-591-1982
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Fax |
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Provider Business Mailing Address
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Address Line | 44 SYLVAN AVE STE 1B
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2417
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Country | US
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Telephone | 646-247-9047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV008018-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00664600
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License Number State | NJ
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