Provider Demographics
NPI:1619046869
Name:LEUNG, WINIFRED FONG (MD)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:FONG
Last Name:LEUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WINIFRED
Other - Middle Name:
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3185 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:732-422-4889
Mailing Address - Fax:732-940-8724
Practice Address - Street 1:3185 ROUTE 27
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823
Practice Address - Country:US
Practice Address - Phone:732-422-4889
Practice Address - Fax:732-940-8724
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07998500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088498Medicaid
H58878Medicare UPIN
NJ098656UA1Medicare PIN