1023615747 NPI number — MS. WINNIE MING WONG MS, LCAT, BC-DMT

Table of content: MS. WINNIE MING WONG MS, LCAT, BC-DMT (NPI 1023615747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023615747 NPI number — MS. WINNIE MING WONG MS, LCAT, BC-DMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
WINNIE
Provider Middle Name:
MING
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LCAT, BC-DMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023615747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 CROWN ST APT D18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11225-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-888-4594
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 CLARKSON AVE R BUILDING
Provider Second Line Business Practice Location Address:
IDD/MH UNIT, R5WEST
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-245-6815
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2020

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: 225600000X , with the licence number:  002092 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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