Provider Demographics
NPI:1053497156
Name:WONG, MARTHA SHIH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:SHIH
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YA-MEI
Other - Middle Name:
Other - Last Name:SHIH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2003
Mailing Address - Country:US
Mailing Address - Phone:718-665-7384
Mailing Address - Fax:718-665-5335
Practice Address - Street 1:860 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2814
Practice Address - Country:US
Practice Address - Phone:718-665-7384
Practice Address - Fax:718-665-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113881208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00208131Medicaid