Provider Demographics
NPI:1700832573
Name:WONG, AUSTIN H (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:H
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 POLIFLY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1749
Mailing Address - Country:US
Mailing Address - Phone:201-441-9980
Mailing Address - Fax:201-441-9948
Practice Address - Street 1:155 POLIFLY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1758
Practice Address - Country:US
Practice Address - Phone:201-487-7617
Practice Address - Fax:201-342-5341
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA076077002080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026476Medicaid
NJ0026476Medicaid