MEDICARE: DR. MAN-CHIU WONG MD

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	133101	NY
2	208000000X	Pediatrics Physician	133101	NY

General Provider Information

NPI Number	:	1821057555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAN-CHIU WONG MD

Provider Business Mailing Address
First Line	:	33 BOWERY
Second Line	:	B201
City	:	NEW YORK
State	:	NY
Zip	:	10002-6745
Country	:	US
Telephone Number	:	212-431-3111
Fax Number	:	212-966-3768

Provider Business Practice Location Address
First Line	:	33 BOWERY
Second Line	:	B201
City	:	NEW YORK
State	:	NY
Zip	:	10002-6745
Country	:	US
Telephone Number	:	212-431-3111
Fax Number	:	212-966-3768

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/27/2010

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