Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 254271 | NY |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 54528 | CT |
NPI | 1346474202 |
---|---|
Provider Name | Dr. Jennifer Lee Wong |
First Address | New Haven, CT 06520-8063 |
Second Address | New Haven, CT 06519-1369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03460964 | (05) | NY |