Provider Demographics
NPI:1700854437
Name:FONG, SENGHAO (MD)
Entity Type:Individual
Prefix:
First Name:SENGHAO
Middle Name:
Last Name:FONG
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 1:20 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3759
Mailing Address - Country:US
Mailing Address - Phone:631-226-2230
Mailing Address - Fax:631-226-3024
Practice Address - Street 1:20 W JOHN ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3759
Practice Address - Country:US
Practice Address - Phone:631-226-2230
Practice Address - Fax:631-226-3024
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1142562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGOtherMEDICARE PTAN
C08295Medicare UPIN
NYPENDINGOtherMEDICARE PTAN