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General NPI Number Information
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NPI Number | 1275151839
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Entity Type | Individual
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Provider Name | FANNY WONG DC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 253 S WASHINGTON AVE STE 1A
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City | BERGENFIELD
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State | NJ
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Zip | 07621-3739
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Country | US
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Telephone | 201-338-4053
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MADISON AVE APT 3
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City | JERSEY CITY
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State | NJ
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Zip | 07304-2855
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Country | US
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Telephone |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00772800
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License Number State | NJ
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