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NPI Code Detail

MEDICARE: JESSICA VENESSA WONG

MEDICARE: JESSICA VENESSA WONG
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
1225X00000XOccupational Therapist014895-1NY

General Provider Information

NPI Number : 1912272915
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA VENESSA WONG
Provider Business Mailing Address
First Line : 62 PARK PL
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3208
Country : US
Telephone Number : 718-789-1191
Fax Number :
Provider Business Practice Location Address
First Line : 62 PARK PL
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3208
Country : US
Telephone Number : 718-789-1191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2012
Last Update Date : 03/09/2012

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