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NPI Code Detail

MEDICARE: DOCTOR GONG INTERNAL MEDICINE CLINIC

MEDICARE: DOCTOR GONG INTERNAL MEDICINE CLINIC
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1902520166
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOCTOR GONG INTERNAL MEDICINE CLINIC
Provider Business Mailing Address
First Line : 68 HOLLAND AVE
Second Line : 68 HOLLAND AVE
City : DEMAREST
State : NJ
Zip : 07627-2715
Country : US
Telephone Number : 201-658-3148
Fax Number :
Provider Business Practice Location Address
First Line : 560 SYLVAN AVE STE 1150
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-3117
Country : US
Telephone Number : 201-497-4018
Fax Number : 845-250-3261
Authorized Official
Title or Position : OWNER
Name : BING GONG
Credential : MD
Telephone Number : 201-658-3148
Provider Enumeration Date : 09/30/2022
Last Update Date : 06/01/2026

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Directions to “DOCTOR GONG INTERNAL MEDICINE CLINIC ” Practice Location

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