Provider Demographics
NPI:1083890313
Name:WONG, ANITA (MPH, RD, CNSC, CDN)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MPH, RD, CNSC, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:DEPARTMENT OF FOOD AND NUTRITION
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:917-861-4484
Mailing Address - Fax:
Practice Address - Street 1:6519 BORDEN AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1630
Practice Address - Country:US
Practice Address - Phone:718-899-0060
Practice Address - Fax:718-899-0175
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal