Active NPI
Stephanie Fong, PHARMD
- Pharmacist
- New York, NY
National Provider Identifier
1750649117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 056646-1
- Practice address
- 3387 Broadway
New York, NY 10031-7416 - Phone
- (917) 507-0179
- NPI assigned
- Apr 23, 2012
- Last updated
- Jul 20, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 056646-1 | NY | Primary |
| Pharmacist | 183500000X | 28RI03478700 | NJ |
Addresses
Primary practice location
3387 Broadway
New York, NY 10031-7416
Mailing address
3387 Broadway
New York, NY 10031-7416
Phone (917) 507-0179
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28RI03478700 | Other | NJ | NJ STATE LICENSE NO. |
| 056646-1 | Other | NY | NY STATE LICENSE NO. |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03478700 | NJ | MD | Pharmacist |
| 056646-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342742400000",
"number": "1750649117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3387 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100317416",
"telephone_number": "917-507-0179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3387 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100317416",
"telephone_number": "917-507-0179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONG",
"first_name": "STEPHANIE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-23",
"last_updated": "2012-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "056646-1",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03478700",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ STATE LICENSE NO.",
"identifier": "28RI03478700",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY STATE LICENSE NO.",
"identifier": "056646-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.