Provider Demographics
NPI:1437937638
Name:VONG, KHANH
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:VONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3917
Mailing Address - Country:US
Mailing Address - Phone:845-689-5289
Mailing Address - Fax:
Practice Address - Street 1:15 SUFFERN PL STE A
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5566
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY871587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse