MEDICARE: MISS CHATTY 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
1	363LP0200X	Pediatric Nurse Practitioner	382783	NY
2	163W00000X	Registered Nurse	664178-1	NY

General Provider Information

NPI Number	:	1780092593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHATTY WONG

Provider Business Mailing Address
First Line	:	226 E 95TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-4036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 E 95TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-4036
Country	:	US
Telephone Number	:	917-238-1523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	04/25/2025

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