MEDICARE: DR. JASON WONG DO

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	25MB05817600	NJ
2	207X00000X	Orthopaedic Surgery Physician	25MB05817600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841216850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON WONG DO

Provider Business Mailing Address
First Line	:	1173 BEACON AVE STE B
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-2531
Country	:	US
Telephone Number	:	732-840-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1173 BEACON AVE STE B
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-2531
Country	:	US
Telephone Number	:	732-840-7500
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/04/2024

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Directions to “ DR. JASON WONG DO” Practice Location

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