Provider Demographics
NPI:1619196516
Name:RAYMOND FONG MD, PC
Entity Type:Organization
Organization Name:RAYMOND FONG MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-762-3790
Mailing Address - Street 1:13620 38TH AVE
Mailing Address - Street 2:SUITE 6H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4233
Mailing Address - Country:US
Mailing Address - Phone:718-762-3790
Mailing Address - Fax:718-762-0138
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:SUITE 6H
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4233
Practice Address - Country:US
Practice Address - Phone:718-762-3790
Practice Address - Fax:718-762-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01949366Medicaid
NY02644Medicare ID - Type UnspecifiedGHI MEDICARE
NY01949366Medicaid