Provider Demographics
NPI:1669041570
Name:WONG-RYAN, LILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:R
Last Name:WONG-RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILLIAM
Other - Middle Name:R
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 UNIVERSITY PLAZA
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-487-9104
Mailing Address - Fax:585-206-4958
Practice Address - Street 1:3 UNIVERSITY PLAZA
Practice Address - Street 2:SUITE 117
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-9104
Practice Address - Fax:585-206-4958
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1766412084P0800X, 2084P0804X
NJ25MA055779002084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry