Provider Demographics
NPI:1780863720
Name:PETER WONG MD
Entity Type:Organization
Organization Name:PETER WONG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-446-4404
Mailing Address - Street 1:601 PAVONIA AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2922
Mailing Address - Country:US
Mailing Address - Phone:201-446-4404
Mailing Address - Fax:973-228-2928
Practice Address - Street 1:601 PAVONIA AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2922
Practice Address - Country:US
Practice Address - Phone:201-446-4404
Practice Address - Fax:973-228-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48180207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCI8963OtherRAILROAD MEDICARE
NJ024841Medicare PIN
NJCI8963OtherRAILROAD MEDICARE