Provider Demographics
NPI:1255426888
Name:TONG, BENJAMIN ANDREW (MS, PA-C, EMT-P)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ANDREW
Last Name:TONG
Suffix:
Gender:M
Credentials:MS, PA-C, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:395 SHADY OAKS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2567
Mailing Address - Country:US
Mailing Address - Phone:248-236-5377
Mailing Address - Fax:
Practice Address - Street 1:28200 JOHN R
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-547-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004891363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical