Provider Demographics
NPI:1598769994
Name:WONG, HENRY C (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3799 ROUTE 46
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-335-1440
Mailing Address - Fax:973-335-1446
Practice Address - Street 1:3799 ROUTE 46
Practice Address - Street 2:SUITE 211
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-335-1440
Practice Address - Fax:973-335-1446
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD044489L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA672628Medicare ID - Type UnspecifiedMC
E86539Medicare UPIN