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General NPI Number Information
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NPI Number | 1528345410
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Entity Type | Organization
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Legal Business Name | CYNTHIA WONG, MD, PC
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 1102 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3622
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Country | US
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Telephone | 718-227-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 45 POMPEY AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2050
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Country | US
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Telephone | 718-227-3233
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Fax |
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Authorized Official
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Title or Position | EXCECUTIVE
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Name | DR. CYNTHIA WONG
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Credential |
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Telephone | 718-227-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 183920
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License Number State | NY
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