Provider Demographics
NPI:1962821058
Name:WONG, ERIC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
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 1:6030 83RD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5444
Mailing Address - Country:US
Mailing Address - Phone:917-887-2062
Mailing Address - Fax:
Practice Address - Street 1:160 NW 170TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5576
Practice Address - Country:US
Practice Address - Phone:305-651-1100
Practice Address - Fax:610-278-2832
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-SE-1762207R00000X
PAMD466354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine