Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 008260 | CT |
N | 1223E0200X | Endodontist | 043855-1 | NY |
NPI | 1043364102 |
---|---|
Provider Name | Dr. Irene Wong |
First Address | Stamford, CT 06905-5546 |
Second Address | Stamford, CT 06905-5546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |