Healthcare Provider Details

I. General information

NPI: 1124258488
Provider Name (Legal Business Name): SUSAN J. WONG-COHEN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ROUTE 37
NEW FAIRFIELD CT
06812
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1714
US

V. Phone/Fax

Practice location:
  • Phone: 203-312-0211
  • Fax: 203-312-0201
Mailing address:
  • Phone: 203-740-0020
  • Fax: 203-775-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003630
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: