Healthcare Provider Details

I. General information

NPI: 1487519872
Provider Name (Legal Business Name): MICHELLE A KONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MADISON AVE FL 5
NEW YORK NY
10016-6796
US

IV. Provider business mailing address

20 WHITEHALL AVE
EDISON NJ
08820-2622
US

V. Phone/Fax

Practice location:
  • Phone: 646-374-8277
  • Fax:
Mailing address:
  • Phone: 732-710-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01272900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number30794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: