Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 028026 | NY |
NPI | 1083869077 |
---|---|
Provider Name | Mercenita Padama Wong |
First Address | Elmhurst, NY 11373-4273 |
Second Address | Bronx, NY 10461-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 18/11/2008 |