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NPI Code Detail

MEDICARE: JOHNNY K WONG

MEDICARE: JOHNNY K WONG
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
1101YM0800XMental Health CounselorNY
2103TC0700XClinical Psychologist028184NY

General Provider Information

NPI Number : 1518680719
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY K WONG
Provider Business Mailing Address
First Line : 2846 STILLWELL AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2624
Country : US
Telephone Number : 718-975-4888
Fax Number :
Provider Business Practice Location Address
First Line : 2846 STILLWELL AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2624
Country : US
Telephone Number : 718-975-4888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2022
Last Update Date : 06/11/2026

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