Provider Demographics
NPI:1306010772
Name:SY, SHELDON ONG (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:ONG
Last Name:SY
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 1:1812 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3706
Mailing Address - Country:US
Mailing Address - Phone:718-693-9095
Mailing Address - Fax:917-900-1413
Practice Address - Street 1:1812 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3706
Practice Address - Country:US
Practice Address - Phone:718-693-9095
Practice Address - Fax:917-900-1413
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03374238Medicaid
NYA400056289Medicare PIN