Active NPI
Lucy A. Chan-Wong, D.M.D.
- Pediatric Dentistry
- Roselle, NJ
National Provider Identifier
1679614739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DI 13810
- Practice address
- 2209 Wood Ave
Roselle, NJ 07203-2930 - Phone
- (908) 245-5556
- NPI assigned
- Feb 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | DI 13810 | NJ | Primary |
Addresses
Primary practice location
2209 Wood Ave
Roselle, NJ 07203-2930
Mailing address
2209 Wood Ave
Roselle, NJ 07203-2930
Phone (908) 245-5556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3336301 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI 13810 | NJ | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Dental Health Associates of Roselle P.C. | Pediatric Dentistry | Past | Accepting new patients |
| Tender Smiles of Roselle PA | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Roselle, NJ
- NPI 1184000457
-
- Pediatric Dentistry
- Linden, NJ
- NPI 1063999506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679614739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2209 WOOD AVE",
"city": "ROSELLE",
"state": "NJ",
"postal_code": "072032930",
"telephone_number": "908-245-5556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2209 WOOD AVE",
"city": "ROSELLE",
"state": "NJ",
"postal_code": "072032930",
"telephone_number": "908-245-5556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN-WONG",
"first_name": "LUCY",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NJ",
"license": "DI 13810",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3336301",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roselle, NJ
- Carlos B Carino, RPH
- Cedar Harbor Medical Day Care Center
- Center for Family Support, New Jersey, Inc.
- Center for Oral Surgery & Dental Implants of Roselle LLC
- Pierrette Cesar, LMSW
- Children'S Dental Health Associates of Roselle P.C.
- Cobar LLC
- Charles L. Coble, PT
- Zaire Sameer Codrington
- Community Access Unlimitd Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.