Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 217598 | NY |
NPI | 1013982685 |
---|---|
Provider Name | Nelson Wong |
First Address | Middletown, NY 10940 |
Second Address | Middletown, NY 10940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 03/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02088562 | (05) | NY |
H19235 | (02) |