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General NPI Number Information
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NPI Number | 1366181059
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Entity Type | Individual
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Provider Name | KEVIN WONG CNIM
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Gender | Male
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 100 MERRICK RD
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4800
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Country | US
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Telephone | 516-321-2589
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Fax |
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Provider Business Mailing Address
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Address Line | 50 WINTER ST
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City | QUINCY
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State | MA
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Zip | 02169-8726
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Country | US
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Telephone | 178-188-8229
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 4964
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License Number State | MA
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