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NPI Code Detail

MEDICARE: DAVID JACOB WONG PT, DPT, OCS

MEDICARE: DAVID JACOB WONG PT, DPT, OCS
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
12251X0800XOrthopedic Physical Therapist40QA01768200NJ
22251X0800XOrthopedic Physical Therapist048026NY

General Provider Information

NPI Number : 1568977585
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID JACOB WONG PT, DPT, OCS
Provider Business Mailing Address
First Line : 1529 STADIUM AVE
Second Line :
City : BRONX
State : NY
Zip : 10465-1115
Country : US
Telephone Number : 347-556-8835
Fax Number :
Provider Business Practice Location Address
First Line : 815 HUTCHINSON RIVER PKWY
Second Line :
City : BRONX
State : NY
Zip : 10465-1887
Country : US
Telephone Number : 347-991-7782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2017
Last Update Date : 05/25/2026

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