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General NPI Number Information
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NPI Number | 1902242993
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Entity Type | Organization
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Legal Business Name | RAYMOND FONG MD PC
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 859 60TH ST SUITE CM1B
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City | BROOKLYN
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State | NY
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Zip | 11220-4352
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Country | US
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Telephone | 718-436-8850
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Fax | 718-436-8857
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Provider Business Mailing Address
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Address Line | 13620 38TH AVE SUITE 6H
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City | FLUSHING
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State | NY
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Zip | 11354-4277
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Country | US
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Telephone | 718-762-3790
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Fax | 718-762-0138
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND FONG
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Credential | M.D.
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Telephone | 718-762-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 150422
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License Number State | NY
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