Provider Demographics
NPI:1376866467
Name:WONG, FRANCISCO
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3604
Mailing Address - Country:US
Mailing Address - Phone:212-289-8839
Mailing Address - Fax:212-289-8560
Practice Address - Street 1:2325 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3604
Practice Address - Country:US
Practice Address - Phone:212-289-8839
Practice Address - Fax:212-289-8560
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1144336595OtherNPI
NY01040977Medicaid
NY1144336595OtherNPI