Provider Demographics
NPI:1073508701
Name:WONG, SOMAN MARY (MD)
Entity Type:Individual
Prefix:
First Name:SOMAN
Middle Name:MARY
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:STE 809
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4558
Mailing Address - Country:US
Mailing Address - Phone:212-349-5555
Mailing Address - Fax:212-791-9598
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:STE 809
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4558
Practice Address - Country:US
Practice Address - Phone:212-349-5555
Practice Address - Fax:212-791-9598
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY191580207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13297Medicare UPIN
220481Medicare ID - Type Unspecified