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General NPI Number Information
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NPI Number | 1962821058
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Entity Type | Individual
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Provider Name | ERIC ALAN WONG MD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 160 NW 170TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5576
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Country | US
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Telephone | 305-651-1100
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Fax | 610-278-2832
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Provider Business Mailing Address
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Address Line | 6030 83RD ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-5444
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Country | US
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Telephone | 917-887-2062
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | WV-SE-1762
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD466354
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License Number State | PA
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