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General NPI Number Information
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NPI Number | 1457424392
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Entity Type | Individual
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Provider Name | EDISON WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 668 N ORLANDO AVE STE 1010
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City | MAITLAND
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State | FL
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Zip | 32751-4460
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Country | US
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Telephone | 407-644-0101
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Fax | 321-441-1559
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Provider Business Mailing Address
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Address Line | 668 N ORLANDO AVE STE 1010
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City | MAITLAND
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State | FL
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Zip | 32751-4460
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Country | US
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Telephone | 407-644-0101
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Fax | 321-441-1559
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 040751
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 81293
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License Number State | MA
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