Provider Demographics
NPI:1790759298
Name:WONG, CHUN TUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUN
Middle Name:TUNG
Last Name:WONG
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 1:98 E BROADWAY FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7181
Mailing Address - Country:US
Mailing Address - Phone:212-966-3316
Mailing Address - Fax:212-966-3317
Practice Address - Street 1:98 E BROADWAY FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7181
Practice Address - Country:US
Practice Address - Phone:212-966-3316
Practice Address - Fax:212-966-3317
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217958207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI37041Medicare UPIN