Provider Demographics
NPI:1336391721
Name:ONG, EVADNE CHI (MD)
Entity Type:Individual
Prefix:DR
First Name:EVADNE
Middle Name:CHI
Last Name:ONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 S MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6627
Mailing Address - Country:US
Mailing Address - Phone:716-484-8610
Mailing Address - Fax:716-484-3777
Practice Address - Street 1:15 S MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6627
Practice Address - Country:US
Practice Address - Phone:716-484-8610
Practice Address - Fax:716-484-3777
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267555-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0211591Medicaid
NY03267269Medicaid
NYJ400168942OtherMEDICARE PTAN
NYJ400168942OtherMEDICARE PTAN
NY03267269Medicaid