1710958194 NPI number — MR. HOLLINGTON YUNG TONG DPM

Table of content: MR. HOLLINGTON YUNG TONG DPM (NPI 1710958194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710958194 NPI number — MR. HOLLINGTON YUNG TONG DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONG
Provider First Name:
HOLLINGTON
Provider Middle Name:
YUNG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710958194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 HOLLOW BROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALIFON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-832-2043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PROVIDENCE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07974-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-665-0010
Provider Business Practice Location Address Fax Number:
908-665-0510
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  MD00970 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1465309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: T0117827 . This is a "PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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