Healthcare Provider Details

I. General information

NPI: 1912341355
Provider Name (Legal Business Name): AMY WONG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 STEWART AVE STE 103
GARDEN CITY NY
11530-4808
US

IV. Provider business mailing address

3811 204TH ST
BAYSIDE NY
11361-1864
US

V. Phone/Fax

Practice location:
  • Phone: 516-820-1228
  • Fax: 516-631-5657
Mailing address:
  • Phone: 917-378-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number057296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: