Provider Demographics
NPI:1083869077
Name:WONG, MERCENITA PADAMA (PT)
Entity Type:Individual
Prefix:
First Name:MERCENITA
Middle Name:PADAMA
Last Name:WONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MERCENITA
Other - Middle Name:SALVADOR
Other - Last Name:PADAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5147 SIMONSON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4273
Mailing Address - Country:US
Mailing Address - Phone:347-837-5479
Mailing Address - Fax:347-242-2439
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:718-823-5494
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0280262251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics