Provider Demographics
NPI:1205803053
Name:DONG, JINWEN (MD)
Entity type:Individual
Prefix:DR
First Name:JINWEN
Middle Name:
Last Name:DONG
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 1:210 N BELLE MEAD RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3522
Mailing Address - Country:US
Mailing Address - Phone:631-689-1400
Mailing Address - Fax:631-689-1595
Practice Address - Street 1:210 N BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3522
Practice Address - Country:US
Practice Address - Phone:631-689-1400
Practice Address - Fax:631-689-1595
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219464207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH68783Medicare UPIN
NY461P41Medicare ID - Type Unspecified