Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 294693 | NY |
Y | 111NI0900X | Internist | 294693 | NY |
NPI | 1003296674 |
---|---|
Provider Name | Dr. Karen A Wong |
First Address | Mineola, NY 11501-3957 |
Second Address | Mineola, NY 11501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2015 |
Last Update Date | 24/07/2018 |