Healthcare Provider Details

I. General information

NPI: 1285791848
Provider Name (Legal Business Name): AMY WONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOWERY
NEW YORK NY
10002-7576
US

IV. Provider business mailing address

25 BOWERY
NEW YORK NY
10002-6702
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-4420
  • Fax:
Mailing address:
  • Phone: 212-966-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047771-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI02919800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: