Basic Information
| Provider Information | |||||||||
| NPI: | 1679950620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONG | ||||||||
| FirstName: | RAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10 UNION SQ E # 2G | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128446195 | ||||||||
| FaxNumber: | 3232262657 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 UNION SQ E # 2G | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128446195 | ||||||||
| FaxNumber: | 3232262657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2015 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A143843 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 293214 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | RD3232267556 | 05 | CA | MEDICAID |