Healthcare Provider Details

I. General information

NPI: 1750559696
Provider Name (Legal Business Name): LINDA WONG M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY ROOM A1-16
ELMHURST NY
11373
US

IV. Provider business mailing address

7901 BROADWAY # J1
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-2490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number255648
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number255648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: