Provider Demographics
NPI:1346390614
Name:WONG, JUSTIN ONSHEK (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ONSHEK
Last Name:WONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 JEFFREY CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1431
Mailing Address - Country:US
Mailing Address - Phone:732-619-3312
Mailing Address - Fax:
Practice Address - Street 1:37 CLYDE RD STE 104
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5034
Practice Address - Country:US
Practice Address - Phone:732-828-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT6263152W00000X
NJ27OA00607500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU81787Medicare UPIN