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General NPI Number Information
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NPI Number | 1780783498
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Entity Type | Individual
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Provider Name | CHARISSA J WONG MD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 571 CENTRAL AVE STE 101
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-1547
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Country | US
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Telephone | 908-464-4600
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Fax | 908-464-4737
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Provider Business Mailing Address
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Address Line | 571 CENTRAL AVE SUITE 101
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974
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Country | US
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Telephone | 908-464-4600
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Fax | 908-464-4737
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA8601700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA08601700
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License Number State | NJ
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