Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 051491 | NY |
NPI | 1184805343 |
---|---|
Provider Name | Elsa Wong |
First Address | New York, NY 10007-3001 |
Second Address | New York, NY 10007-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 16/11/2007 |