Provider Demographics
NPI:1891751418
Name:WONG, CYNTHIA S (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:INFECTIOUS DISEASE CONSULTANTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-448-6253
Mailing Address - Fax:315-448-6264
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:INFECTIOUS DISEASE CONSULTANTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-448-6253
Practice Address - Fax:315-448-6264
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1655241207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01097236Medicaid
B83055Medicare UPIN
NY01097236Medicaid