Basic Information
| Provider Information | |||||||||
| NPI: | 1033559745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | JIYUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 SYLVAN AVE STE 1B | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD CLIFFS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076322417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462479047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 44 SYLVAN AVE STE 1B | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD CLIFFS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076322417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015911982 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TUV008018-1 | NY | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 27OA00664600 | NJ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.