Active NPI
Willard Wong
- Anatomic Pathology Physician
- New York, NY
National Provider Identifier
1861046260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology Physician
- License
- 100440-01
- Practice address
- 1275 York Ave
New York, NY 10065-6094 - Phone
- (212) 639-7102
- NPI assigned
- Jul 25, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Anatomic Pathology Physician | 207ZP0101X | 100440-01 | NY | Primary |
Addresses
Primary practice location
1275 York Ave
New York, NY 10065-6094
Mailing address
425 E 76TH St Apt 2F
New York, NY 10021-2514
Phone (646) 228-5925
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 |
|---|---|---|---|
| 100440-01 | NY | MD | Anatomic Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564012800000",
"number": "1861046260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 E 76TH ST APT 2F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100212514",
"telephone_number": "646-228-5925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 YORK AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100656094",
"telephone_number": "212-639-7102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "WILLARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-25",
"last_updated": "2019-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "NY",
"license": "100440-01",
"primary": true
}
],
"identifiers": [],
"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 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.