Provider Demographics
NPI:1457573321
Name:LEON-WONG, HECTOR JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:JACOB
Last Name:LEON-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 1:991 ALDUS ST # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3706
Mailing Address - Country:US
Mailing Address - Phone:718-991-6581
Mailing Address - Fax:
Practice Address - Street 1:410 22ND ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4414
Practice Address - Country:US
Practice Address - Phone:201-223-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6750508Medicaid
NJG19660Medicare UPIN
NJLE813458Medicare ID - Type Unspecified