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General NPI Number Information
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NPI Number | 1487641957
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Entity Type | Individual
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Provider Name | LESLIE P WONG MD
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 370 E RIDGE RD STE 20
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City | ROCHESTER
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State | NY
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Zip | 14621-1239
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Country | US
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Telephone | 585-922-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00043067
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | C54492
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 12745135-1205
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 328842
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License Number State | NY
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