Individual
JERALD Z GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
132 S 10TH ST, 285K, PHILADELPHIA, PA 19107-5244
(215) 503-5642
Mailing address
132 S 10TH ST, 285K, PHILADELPHIA, PA 19107-5244
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
99-00847
NC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD438783
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001791400-0004
—
PA
05
—
0223620
—
NJ
Enumeration date
10/25/2006
Last updated
03/25/2015
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