Healthcare Provider Details

I. General information

NPI: 1487567798
Provider Name (Legal Business Name): MATTHEW WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 SUNRISE HWY STE 304
WANTAGH NY
11793-4024
US

IV. Provider business mailing address

512 115TH ST APT C
COLLEGE POINT NY
11356-1044
US

V. Phone/Fax

Practice location:
  • Phone: 347-251-1020
  • Fax:
Mailing address:
  • Phone: 347-251-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: