Provider Demographics
NPI:1285818468
Name:WONG, CHUM-HUNG (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHUM-HUNG
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2516
Mailing Address - Country:US
Mailing Address - Phone:347-351-3599
Mailing Address - Fax:
Practice Address - Street 1:1836 HYLAN BLVD SUITE B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-5020
Practice Address - Country:US
Practice Address - Phone:917-565-8666
Practice Address - Fax:917-565-8685
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047103OtherSTATE BOARD OF PHARMACY