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NPI Code Detail

MEDICARE: ELLEN WONG LMSW

MEDICARE: ELLEN WONG LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker083115-1NY

General Provider Information

NPI Number : 1225335219
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN WONG LMSW
Provider Business Mailing Address
First Line : 3028 48TH ST
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11103-1525
Country : US
Telephone Number : 917-257-5942
Fax Number :
Provider Business Practice Location Address
First Line : 555 W 57TH ST
Second Line : STE. 1326
City : NEW YORK
State : NY
Zip : 10019-2925
Country : US
Telephone Number : 212-376-1810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2011
Last Update Date : 08/14/2013

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