1023085263 NPI number — TONG KAREN HAO MD

Table of content: TONG KAREN HAO MD (NPI 1023085263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023085263 NPI number — TONG KAREN HAO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAO
Provider First Name:
TONG
Provider Middle Name:
KAREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023085263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 MAIDEN CHOICE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-5968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-737-8838
Provider Business Mailing Address Fax Number:
410-314-7979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 ESSEX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-643-2070
Provider Business Practice Location Address Fax Number:
732-643-2015
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA07939400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5221142040 . This is a "BCBS OF NJ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04-09807 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0206229 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52-2117147 . This is a "TRICARE NORTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: A424 . This is a "BCBS OF NJ" identifier . This identifiers is of the category "OTHER".




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