MEDICARE: CHINATOWN GASTROENTEROLOGY, P.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	261QM2500X	Medical Specialty Clinic/Center	217958	NY

General Provider Information

NPI Number	:	1881888634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINATOWN GASTROENTEROLOGY, P.C.

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	:	PRESIDENT
Name	:	DR. CHUN T WONG
Credential	:	M.D.
Telephone Number	:	212-966-3316

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	01/26/2012

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