MEDICARE: DR. CHUN TUNG WONG M.D.

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	217958	NY
2	207RG0100X	Gastroenterology Physician	217958	NY

General Provider Information

NPI Number	:	1790759298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUN TUNG WONG M.D.

Provider Business Mailing Address
First Line	:	98 E BROADWAY FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-7181
Country	:	US
Telephone Number	:	212-966-3316
Fax Number	:	212-966-3317

Provider Business Practice Location Address
First Line	:	98 E BROADWAY FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-7181
Country	:	US
Telephone Number	:	212-966-3316
Fax Number	:	212-966-3317

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/03/2011

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