Basic Information
| Provider Information | |||||||||
| NPI: | 1417290768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FONG | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | FRANCES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 E 17TH ST | ||||||||
| Address2: | BAIRD HALL SUITE 16BH40 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124203960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 353 E 17TH ST FL 2 | ||||||||
| Address2: | BETH ISRAEL MEDICAL CENTER | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124203743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2013 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 293158 | NY | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.