Provider Demographics
NPI:1629057971
Name:KONG, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 JAMAICA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3758
Mailing Address - Country:US
Mailing Address - Phone:732-341-4400
Mailing Address - Fax:732-341-4450
Practice Address - Street 1:730 JAMAICA BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3758
Practice Address - Country:US
Practice Address - Phone:732-341-4400
Practice Address - Fax:732-341-4450
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH60485Medicare UPIN
NJ057772Medicare PIN