MEDICARE: MS. MARCIA WONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	256523	NY

General Provider Information

NPI Number	:	1114185865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA WONG

Provider Business Mailing Address
First Line	:	345 RIVERSIDE DR APT 5H
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 28TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-758-2789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	01/23/2026

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