Provider Demographics
NPI:1386690683
Name:FONG, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 STRAUBE CENTER BLVD
Mailing Address - Street 2:BOX H1
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1447
Mailing Address - Country:US
Mailing Address - Phone:609-737-7797
Mailing Address - Fax:609-737-7499
Practice Address - Street 1:100 STRAUBE CENTER BLVD
Practice Address - Street 2:BOX H1
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1447
Practice Address - Country:US
Practice Address - Phone:609-737-7797
Practice Address - Fax:609-737-7499
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA066431002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFO953052Medicare ID - Type Unspecified