Provider Demographics
NPI:1851791479
Name:SW WONG LLC
Entity Type:Organization
Organization Name:SW WONG LLC
Other - Org Name:SHOESTERS SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:WAI
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:856-829-2931
Mailing Address - Street 1:69 CLEMENTON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1369
Mailing Address - Country:US
Mailing Address - Phone:856-809-2931
Mailing Address - Fax:856-809-2183
Practice Address - Street 1:69 CLEMENTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1369
Practice Address - Country:US
Practice Address - Phone:856-809-2931
Practice Address - Fax:856-809-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies