Provider Demographics
NPI:1811916745
Name:WONG, GEOFFREY (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 PARK AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5516
Mailing Address - Country:US
Mailing Address - Phone:908-561-9500
Mailing Address - Fax:908-561-7162
Practice Address - Street 1:1511 PARK AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5516
Practice Address - Country:US
Practice Address - Phone:908-561-9500
Practice Address - Fax:908-561-7162
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080996002086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6485178OtherCIGNA
NJ2675738OtherUNITED HEALTHCARE
7731734OtherAETNA
NJP3701421OtherOXFORD
P00326391Medicare PIN
NJ102153MLAMedicare PIN
7731734OtherAETNA