Healthcare Provider Details

I. General information

NPI: 1518299965
Provider Name (Legal Business Name): PUI YIU CORINA WONG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOND ST
GREAT NECK NY
11021-2408
US

IV. Provider business mailing address

1 BOND ST
GREAT NECK NY
11021-2408
US

V. Phone/Fax

Practice location:
  • Phone: 516-858-9276
  • Fax: 516-441-5882
Mailing address:
  • Phone: 516-858-9276
  • Fax: 516-441-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberP74127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: