Organization Active NPI

Raymond Fong MD, PC

  • Ophthalmology Physician
  • Flushing, NY
National Provider Identifier
1619196516
Registry record updated Nov 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
RAYMOND FONG MD, PC
Practice address
13620 38TH Ave
Suite 6H
Flushing, NY 11354-4233
Phone
(718) 762-3790
Fax
(718) 762-3801
NPI assigned
Apr 25, 2007
Last updated
Nov 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Raymond Fong, M.D.NPI 1730181868
Title
President
Phone
(718) 762-3790

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

13620 38TH Ave
Suite 6H
Flushing, NY 11354-4233

Mailing address

13620 38TH Ave
Suite 6H
Flushing, NY 11354-4233
Phone (718) 762-3790

Other identifiers 1

IdentifierTypeStateIssuer
01949366MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040109000256 NY Part B Supplier - Clinic/Group Practice 5496655292 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flushing, NY; New York, NY; Brooklyn, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Raymond Fong MD PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6402 8th Ave
Ste 302
Brooklyn, NY 11220
Phone (516) 610-3711

13681 Roosevelt Ave
Ste 2
Flushing, NY 11354
Phone (718) 353-4777

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1619196516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13620 38TH AVE",
            "address_2": "SUITE 6H",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113544233",
            "telephone_number": "718-762-3790",
            "fax_number": "718-762-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13620 38TH AVE",
            "address_2": "SUITE 6H",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113544233",
            "telephone_number": "718-762-3790",
            "fax_number": "718-762-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYMOND FONG MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-762-3790",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01949366",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.