=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396248142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY H WONG TEACHER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2018
-----------------------------------------------------
Last Update Date | 03/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 SAINT NICHOLAS AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11237-3491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-745-7464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5412 253RD ST
-----------------------------------------------------
City | LITTLE NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11362-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-608-7892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 661694
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------