Provider Demographics
NPI:1275588030
Name:SOO WOONG HONG MD PC
Entity Type:Organization
Organization Name:SOO WOONG HONG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOO
Authorized Official - Middle Name:W
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-5310
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0240
Mailing Address - Country:US
Mailing Address - Phone:518-272-5310
Mailing Address - Fax:518-272-5317
Practice Address - Street 1:1444 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1600
Practice Address - Country:US
Practice Address - Phone:518-272-5310
Practice Address - Fax:518-272-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1175181208100000X
NY1215331208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33743AMedicare ID - Type UnspecifiedGROUP MEDICARE #