Individual
EDISON WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
668 N ORLANDO AVE STE 1010, MAITLAND, FL 32751-4460
(407) 644-0101
(321) 441-1559
Mailing address
668 N ORLANDO AVE STE 1010, MAITLAND, FL 32751-4460
(407) 644-0101
(321) 441-1559
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
040751
CT
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
81293
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30555
FALLON
MA
05
—
3139875
—
MA
01
—
758575
TUFTS
MA
01
—
80911
HARV PILGRIM
MA
01
—
972848
NETWORK HEALTH
MA
01
—
J31343
BCBS
MA
01
—
P00132480
MR RR
MA
Enumeration date
11/16/2006
Last updated
04/21/2020
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