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General NPI Number Information
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NPI Number | 1679863385
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Entity Type | Individual
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Provider Name | KAREN BETH WONG DPT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 141 MARK TREE RD
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City | CENTEREACH
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State | NY
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Zip | 11720-2221
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Country | US
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Telephone | 631-467-4235
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Fax |
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Provider Business Mailing Address
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Address Line | 147 SOTZEN AVE
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City | HOLBROOK
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State | NY
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Zip | 11741-3224
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Country | US
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Telephone | 646-796-6452
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 032009
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License Number State | NY
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