Provider Demographics
NPI:1164534673
Name:WONG, DENNIS KA-CHEONG (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KA-CHEONG
Last Name:WONG
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 1:34 NEW ENGLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2028
Mailing Address - Country:US
Mailing Address - Phone:973-263-0429
Mailing Address - Fax:
Practice Address - Street 1:34 NEW ENGLAND DR
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2028
Practice Address - Country:US
Practice Address - Phone:973-263-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190934208100000X
NY6277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01450540Medicaid
F61800Medicare UPIN
NY75H521Medicare ID - Type Unspecified