Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N006302 | NY |
NPI | 1245475581 |
---|---|
Provider Name | Dr. David Tom Wong |
First Address | Bronx, NY 10457-7606 |
Second Address | Bronx, NY 10457-7606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 12/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03399731 | (05) | NY |