Provider Demographics
NPI:1316151244
Name:CHAN, WING HONG (PT)
Entity type:Individual
Prefix:
First Name:WING HONG
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MAIN ST
Mailing Address - Street 2:STE 509
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5433
Mailing Address - Country:US
Mailing Address - Phone:917-908-0207
Mailing Address - Fax:917-908-0205
Practice Address - Street 1:3901 MAIN ST
Practice Address - Street 2:STE 509
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5433
Practice Address - Country:US
Practice Address - Phone:917-908-0207
Practice Address - Fax:917-908-0205
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023417-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist