Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 056838-1 | NY |
N | 1223P0300X | Periodontist | 22DI02671600 | NJ |
NPI | 1093073637 |
---|---|
Provider Name | Dr. Christine N Wong |
First Address | Fort Lee, NJ 07024-7002 |
Second Address | New York, NY 10016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03709102 | (05) | NY |