Provider Demographics
NPI:1093727612
Name:HONG, DONG GI (MD)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:GI
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LEACH RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9732
Mailing Address - Country:US
Mailing Address - Phone:315-946-6075
Mailing Address - Fax:315-946-4254
Practice Address - Street 1:12 LEACH RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9732
Practice Address - Country:US
Practice Address - Phone:315-946-6075
Practice Address - Fax:315-946-4254
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462262Medicaid
NYD79098Medicare UPIN
NYBB2481Medicare ID - Type Unspecified