1558800763 NPI number — TIFFANY YU TUNG WONG

Table of content: TIFFANY YU TUNG WONG (NPI 1558800763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558800763 NPI number — TIFFANY YU TUNG WONG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
TIFFANY YU TUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1558800763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/11/2024
NPI Reactivation Date:
11/26/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 WASHINGTON SQ W
Provider Second Line Business Mailing Address:
508
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10011-9154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-606-0402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 AUSTIN ST
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-762-7633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2017

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: 106S00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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