Provider Demographics
NPI:1265428130
Name:ONG, PEDRO DY JR (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:DY
Last Name:ONG
Suffix:JR
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 1:8320 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2011
Mailing Address - Country:US
Mailing Address - Phone:718-845-8525
Mailing Address - Fax:
Practice Address - Street 1:8320 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2011
Practice Address - Country:US
Practice Address - Phone:718-845-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00200753Medicaid
B58761Medicare UPIN
NY82182AMedicare ID - Type Unspecified