Provider Demographics
NPI:1376647834
Name:WONG, LEUNG-WING (MD)
Entity Type:Individual
Prefix:DR
First Name:LEUNG-WING
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALFRED
Other - Middle Name:L
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:763 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3529
Mailing Address - Country:US
Mailing Address - Phone:718-567-3667
Mailing Address - Fax:718-567-2332
Practice Address - Street 1:763 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3529
Practice Address - Country:US
Practice Address - Phone:718-567-3667
Practice Address - Fax:718-567-2332
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547635Medicaid
NY03112287Medicaid
NYA400021739Medicare Oscar/Certification
WO0655742Medicare ID - Type Unspecified
OH0547635Medicaid