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General NPI Number Information
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NPI Number | 1154505626
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Entity Type | Individual
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Provider Name | MR. WAIWAH WONG
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Gender | Male
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 1111 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6702
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Country | US
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Telephone | 212-838-0195
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Fax | 212-838-0341
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Provider Business Mailing Address
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Address Line | 4857 208TH ST
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-1116
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Country | US
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Telephone | 718-352-0326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 047696
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License Number State | NY
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