Provider Demographics
NPI:1376391508
Name:WONG, JEROME (RN, CSN-NJ)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RN, CSN-NJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EVELYN PL
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1231
Mailing Address - Country:US
Mailing Address - Phone:862-228-1689
Mailing Address - Fax:
Practice Address - Street 1:5200 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2638
Practice Address - Country:US
Practice Address - Phone:201-553-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13858800163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool