Provider Demographics
NPI:1396068995
Name:WONG, JOHN J (NP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:WONG
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-979-0661
Mailing Address - Fax:
Practice Address - Street 1:360 HUNTINGTON AVE
Practice Address - Street 2:135 FORSYTH BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5005
Practice Address - Country:US
Practice Address - Phone:617-373-2803
Practice Address - Fax:617-373-2601
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2017-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA254638363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care