1336550052 NPI number — CARMEN K. WONG

Table of content: CARMEN K. WONG (NPI 1336550052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336550052 NPI number — CARMEN K. WONG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
CARMEN
Provider Middle Name:
K.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAU
Provider Other First Name:
CARMEN
Provider Other Middle Name:
K.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336550052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6344 SAUNDERS ST APT 2D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-819-6888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8114 QUEENS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-3789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-899-9810
Provider Business Practice Location Address Fax Number:
718-899-9699
Provider Enumeration Date:
05/15/2014

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: 390200000X , with the licence number:  C32561117258832 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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