Provider Demographics
NPI:1154507002
Name:WONG, PETER CHIN-HEI
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHIN-HEI
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4610
Mailing Address - Country:US
Mailing Address - Phone:718-439-4966
Mailing Address - Fax:718-439-4972
Practice Address - Street 1:6112 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4610
Practice Address - Country:US
Practice Address - Phone:718-439-4966
Practice Address - Fax:718-439-4972
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02498153Medicaid
NY02498153Medicaid
5064190001Medicare Oscar/Certification
5064190001Medicare NSC
5064190001Medicare PIN