Provider Demographics
NPI:1588867287
Name:WONG, JULIELYNN (MD, MPH, FACPM)
Entity type:Individual
Prefix:DR
First Name:JULIELYNN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD, MPH, FACPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 RAINBOW BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-1224
Mailing Address - Country:US
Mailing Address - Phone:716-550-6361
Mailing Address - Fax:716-214-3004
Practice Address - Street 1:250 RAINBOW BLVD APT 102
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1224
Practice Address - Country:US
Practice Address - Phone:716-550-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263890-012083C0008X, 208D00000X, 2083P0901X, 2083X0100X, 2083A0100X
NY263890208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine