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General NPI Number Information
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NPI Number | 1346390614
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Entity Type | Individual
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Provider Name | JUSTIN ONSHEK WONG O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 37 CLYDE RD STE 104
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City | SOMERSET
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State | NJ
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Zip | 08873-5034
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Country | US
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Telephone | 732-828-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 53 JEFFREY CIR
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City | DAYTON
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State | NJ
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Zip | 08810-1431
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Country | US
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Telephone | 732-619-3312
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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 | T6263
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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 | 27OA00607500
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License Number State | NJ
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