Provider Demographics
NPI:1154505626
Name:WONG, WAIWAH
Entity type:Individual
Prefix:MR
First Name:WAIWAH
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4857 208TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1116
Mailing Address - Country:US
Mailing Address - Phone:718-352-0326
Mailing Address - Fax:
Practice Address - Street 1:1111 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6702
Practice Address - Country:US
Practice Address - Phone:212-838-0195
Practice Address - Fax:212-838-0341
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist