Provider Demographics
NPI:1346226834
Name:WONG, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
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 1:232 BOSTON POST RD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3158
Mailing Address - Country:US
Mailing Address - Phone:203-876-2179
Mailing Address - Fax:
Practice Address - Street 1:232 BOSTON POST RD
Practice Address - Street 2:UNIT 11
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3158
Practice Address - Country:US
Practice Address - Phone:203-876-2179
Practice Address - Fax:203-876-2369
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037255208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010037255CT05OtherANTHEM BLUE CROSS BLUE SH
CT7040792748OtherCONNECTICARE
CTP3201029OtherOXFORD
CTP3201029OtherOXFORD