Provider Demographics
NPI:1467699298
Name:WONG, CYNTHIA (RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BAY 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3417
Mailing Address - Country:US
Mailing Address - Phone:347-946-4245
Mailing Address - Fax:
Practice Address - Street 1:16 BAY 8TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3417
Practice Address - Country:US
Practice Address - Phone:347-946-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006586-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered