Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MA07868000 | NJ |
NPI | 1194759225 |
---|---|
Provider Name | Dr. Gabriel Ho Yu Wong |
First Address | Marlton, NJ 08053-4112 |
Second Address | Marlton, NJ 08053-4168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I42281 | (02) |