Provider Demographics
NPI:1457492217
Name:KONG, PHILOMENA WAH (MD)
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:WAH
Last Name:KONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-0995
Mailing Address - Country:US
Mailing Address - Phone:518-862-9580
Mailing Address - Fax:518-862-9579
Practice Address - Street 1:2498 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009
Practice Address - Country:US
Practice Address - Phone:518-862-9580
Practice Address - Fax:518-862-9579
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA188314171100000X
NYA1883141208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation