Provider Demographics
NPI:1689070690
Name:CHOE, WONSICK
Entity Type:Individual
Prefix:
First Name:WONSICK
Middle Name:
Last Name:CHOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1063
Mailing Address - Country:US
Mailing Address - Phone:718-594-5868
Mailing Address - Fax:
Practice Address - Street 1:115 N COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1063
Practice Address - Country:US
Practice Address - Phone:718-594-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42362208D00000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice