Provider Demographics
NPI:1457742843
Name:TONGSON, KRYSTINA (DO)
Entity Type:Individual
Prefix:DR
First Name:KRYSTINA
Middle Name:
Last Name:TONGSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST 77TH STREET, 3 WOLLMAN
Mailing Address - Street 2:ATTN: LAURA HNATH, OFFICE MANAGER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-434-4218
Mailing Address - Fax:212-434-6950
Practice Address - Street 1:100 EAST 77TH STREET, 3 WOLLMAN
Practice Address - Street 2:ATTN: LAURA HNATH, OFFICE MANAGER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-4218
Practice Address - Fax:212-434-6950
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY294952208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program