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General NPI Number Information
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NPI Number | 1962975615
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Entity Type | Organization
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Legal Business Name | PT FAMILY MEDICINE PC
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 2057 STATE ROUTE 130
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City | JEANNETTE
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State | PA
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Zip | 15644-3801
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Country | US
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Telephone | 724-527-2700
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Fax | 724-527-2705
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Provider Business Mailing Address
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Address Line | 2057 STATE ROUTE 130
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City | JEANNETTE
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State | PA
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Zip | 15644-3801
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Country | US
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Telephone | 724-527-2700
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Fax | 724-527-2705
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN M WONG
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Credential | MD
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Telephone | 724-527-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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