=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952670572
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLAN Y. JONG, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2011
-----------------------------------------------------
Last Update Date | 12/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 E 85TH ST 3N
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-0954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-861-4861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 E 85TH ST 3N
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-0954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-861-4861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALLAN YOUNG JONG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-861-4861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 089560-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------