Provider Demographics
NPI:1053350777
Name:WONG, JAMES ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5329
Practice Address - Fax:973-290-7393
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA065806002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4000044OtherGHI
NJ1076829OtherHORIZON BCBS
NJ7399201Medicaid
NJ897182000OtherAMERIHEALTH
NJP1107500OtherOXFORD
NY01360530Medicaid
NJ2549497OtherAETNA USHC
NJ897182000OtherAMERIHEALTH
NJF40148Medicare UPIN
NJP1107500OtherOXFORD