Provider Demographics
NPI:1487699021
Name:WONG-TOM, WING MUN (PT, MS, OCS)
Entity type:Individual
Prefix:MRS
First Name:WING MUN
Middle Name:
Last Name:WONG-TOM
Suffix:
Gender:F
Credentials:PT, MS, OCS
Other - Prefix:MS
Other - First Name:WING MUN
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MS, OCS
Mailing Address - Street 1:2 BAYARD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3706
Mailing Address - Country:US
Mailing Address - Phone:917-757-5135
Mailing Address - Fax:917-522-9623
Practice Address - Street 1:2 BAYARD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3706
Practice Address - Country:US
Practice Address - Phone:917-757-5135
Practice Address - Fax:917-522-9623
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1498848OtherGREAT WEST LIFE
NY2022970OtherUNITED HEALTHCARE
NY20-8909574OtherMAGNACARE
NYQ128H1OtherEMPIRE BCBS
NY2022970OtherUNITED HEALTHCARE