=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558760660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TONG MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2014
-----------------------------------------------------
Last Update Date | 03/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 MOTT ST RM 203
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-227-4505
-----------------------------------------------------
Fax | 212-227-4579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MOTT ST RM 203
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-227-4505
-----------------------------------------------------
Fax | 212-227-4579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | XUEZHU TONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-227-4505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 220003
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------