Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 25MA05543600 | NJ |
N | 207RR0500X | Rheumatology | MA55436 | NJ |
NPI | 1003981648 |
---|---|
Provider Name | Dr. Robert Louis Wong |
First Address | New Brunswick, NJ 08901-1962 |
Second Address | New Brunswick, NJ 08901-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4551605 | (05) | NJ |
E83860 | (02) | NJ |