MEDICARE: JIMMY WONG M.D., P.L.L.C.

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	207R00000X	Internal Medicine Physician	249942	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A300000825	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1114162898	OTHER	NY	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316271604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMMY WONG M.D., P.L.L.C.

Provider Business Mailing Address
First Line	:	33 BOWERY
Second Line	:	SUITE B201
City	:	NEW YORK
State	:	NY
Zip	:	10002-6745
Country	:	US
Telephone Number	:	212-431-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 BOWERY
Second Line	:	SUITE B201
City	:	NEW YORK
State	:	NY
Zip	:	10002-6745
Country	:	US
Telephone Number	:	212-431-3111
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JIMMY WONG
Credential	:	M.D.
Telephone Number	:	917-660-6227

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	09/20/2009

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