1457426603 NPI number — DR. JOTI MELWANI WONG PT, MA, DPT

Table of content: DR. JOTI MELWANI WONG PT, MA, DPT (NPI 1457426603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457426603 NPI number — DR. JOTI MELWANI WONG PT, MA, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
JOTI
Provider Middle Name:
MELWANI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, MA, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELWANI
Provider Other First Name:
JOTI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, MA, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457426603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 1ST AVE
Provider Second Line Business Mailing Address:
RM 327
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-7404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 1ST AVE
Provider Second Line Business Practice Location Address:
ROOM 327
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-423-7723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006

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: 225100000X , with the licence number:  015886-1 , 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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