Provider Demographics
NPI:1801806062
Name:BINGHAMTON CARDIOVASCULAR & THORACIC SURGEONS, P.C.
Entity type:Organization
Organization Name:BINGHAMTON CARDIOVASCULAR & THORACIC SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:TING-HUNG
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-770-1018
Mailing Address - Street 1:41 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2101
Mailing Address - Country:US
Mailing Address - Phone:607-770-1018
Mailing Address - Fax:607-770-8788
Practice Address - Street 1:41 ARCH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2101
Practice Address - Country:US
Practice Address - Phone:607-770-1018
Practice Address - Fax:607-770-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01958456Medicaid
NY01958456Medicaid