Provider Demographics
NPI:1497114268
Name:WONG, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2416
Mailing Address - Country:US
Mailing Address - Phone:845-454-1025
Mailing Address - Fax:845-454-5881
Practice Address - Street 1:27 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2416
Practice Address - Country:US
Practice Address - Phone:845-454-1025
Practice Address - Fax:845-454-5881
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18437207WX0107X
390200000X
NY312256207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program