Provider Demographics
NPI:1730181868
Name:FONG, RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:FONG
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 1:109 LAFAYETTE ST
Mailing Address - Street 2:FL 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4138
Mailing Address - Country:US
Mailing Address - Phone:212-274-1900
Mailing Address - Fax:212-274-0738
Practice Address - Street 1:109 LAFAYETTE ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4138
Practice Address - Country:US
Practice Address - Phone:212-274-1900
Practice Address - Fax:212-274-0738
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00876848Medicaid
NY180003553Medicare PIN
NYC09931Medicare UPIN
NY44D22X0691Medicare PIN
NY02644GMedicare PIN