Healthcare Provider Details

I. General information

NPI: 1700235140
Provider Name (Legal Business Name): KOSINA WONG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

5033 68TH ST
WOODSIDE NY
11377-7538
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3257
  • Fax: 718-616-3260
Mailing address:
  • Phone: 646-662-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number305788-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: