Provider Demographics
NPI:1821057555
Name:WONG, MAN-CHIU (MD)
Entity Type:Individual
Prefix:DR
First Name:MAN-CHIU
Middle Name:
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 1:33 BOWERY
Mailing Address - Street 2:B201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6745
Mailing Address - Country:US
Mailing Address - Phone:212-431-3111
Mailing Address - Fax:212-966-3768
Practice Address - Street 1:33 BOWERY
Practice Address - Street 2:B201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6745
Practice Address - Country:US
Practice Address - Phone:212-431-3111
Practice Address - Fax:212-966-3768
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133101207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
13A911Medicare ID - Type Unspecified
C05799Medicare UPIN