Provider Demographics
NPI:1063549319
Name:WONG, LINDA (MS)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FLORENCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885
Mailing Address - Country:US
Mailing Address - Phone:973-343-7106
Mailing Address - Fax:
Practice Address - Street 1:141 ROUTE 46E
Practice Address - Street 2:KESSLER REHABILITATION CENTER
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-691-4244
Practice Address - Fax:973-448-9635
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist