Active NPI
Diane M Wong, D.D.S.
- Pediatric Dentistry
- Brooklyn, NY
National Provider Identifier
1114012135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 046946
- Practice address
- 150 55TH St
NYU Lutheran Medical Center - Dental
Brooklyn, NY 11220-2508 - Phone
- (718) 630-6875
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 046946 | NY | Primary |
Addresses
Primary practice location
150 55TH St
NYU Lutheran Medical Center - Dental
Brooklyn, NY 11220-2508
Mailing address
150 55TH St
NYU Lutheran Medical Center - Dental
Brooklyn, NY 11220-2508
Phone (718) 630-6875
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160620002308 | NY | Order and Referring Only - Other (Physician) | 4082905146 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- dwong133148@nyumc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440633600000",
"number": "1114012135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 55TH ST",
"address_2": "NYU LUTHERAN MEDICAL CENTER - DENTAL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112202508",
"telephone_number": "718-630-6875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 55TH ST",
"address_2": "NYU LUTHERAN MEDICAL CENTER - DENTAL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112202508",
"telephone_number": "718-630-6875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "DIANE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2015-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "046946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.