Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 113881 | NY |
N | 2080P0207X | Pediatric Hematology-Oncologist | 113881 | NY |
NPI | 1053497156 |
---|---|
Provider Name | Dr. Martha Shih Wong |
First Address | Scarsdale, NY 10583-2003 |
Second Address | Bronx, NY 10451-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 23/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00208131 | (05) | NY |