NPIMap

Individual provider Active NPI

Irene Wong, D.O.

  • Family Medicine Physician
  • Totowa, NJ
National Provider Identifier
1821362344
Registry record updated Jun 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB10295000 Issued in NJ
Practice address
650 Union Blvd Unit 16
Totowa, NJ 07512
Phone
(973) 938-5200
Fax
(973) 938-5191
NPI assigned
Mar 1, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 260111 NY
Family Medicine Physician 207Q00000X 25MB10295000 NJ Primary

Addresses

Primary practice location

650 Union Blvd Unit 16
Totowa, NJ 07512

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Other identifiers 1

IdentifierTypeStateIssuer
03480408MedicaidNY

Other names 1

  • Dr. Holiam Irene Wong Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120906000217 NY Practitioner - Family Practice 6608023163 Reassigns benefits to 1 organization
I20180814000364 NJ Practitioner - Family Practice 6608023163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

650 Union Blvd
Unit 16
Totowa, NJ 07512-2422
Phone (908) 938-5191

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
260111NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jamaica Hospital CurrentSince Aug 1, 2012 Accepting new patients
Practice Associates Medical Group Family Medicine CurrentSince Jun 16, 2018 Accepting new patients
Jamaica Hospital CurrentSince Aug 1, 2012 Accepting new patients

Locations

465 South St
Ste 200
Morristown, NJ 07960
Phone (973) 971-7130

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

650 Union Blvd
Ste 16
Totowa, NJ 07512
Phone (973) 938-5200

3080 Atlantic Ave
Brooklyn, NY 11208
Phone (718) 647-0240

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Organizations & group practices 3

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1821362344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 UNION BLVD UNIT 16",
            "city": "TOTOWA",
            "state": "NJ",
            "postal_code": "07512",
            "telephone_number": "973-938-5200",
            "fax_number": "973-938-5191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-01",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "260111",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB10295000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03480408",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLIAM",
            "last_name": "WONG",
            "middle_name": "IRENE",
            "prefix": "DR.",
            "credential": "DO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Totowa, NJ

Sources for this page

Verify at the official NPI Registry.