Individual
WILLARD WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1275 YORK AVE, NEW YORK, NY 10065-6094
(212) 639-7102
Mailing address
425 E 76TH ST APT 2F, NEW YORK, NY 10021-2514
(646) 228-5925
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
100440-01
NY
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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