MEDICARE: MS. DOROTHY WONG LAC., LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	003280	NY

General Provider Information

NPI Number	:	1477888147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY WONG LAC., LMT

Provider Business Mailing Address
First Line	:	1570 HILLSIDE AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2527
Country	:	US
Telephone Number	:	516-354-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 HILLSIDE AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2527
Country	:	US
Telephone Number	:	516-354-9197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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