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General NPI Number Information
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NPI Number | 1568725901
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Entity Type | Individual
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Provider Name | ANDREW THOMAS WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 150 PARK AVE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1049
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Country | US
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Telephone | 973-437-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 631-376-4047
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 283528
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 25MA11003200
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License Number State | NJ
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