Provider Demographics
NPI:1477908424
Name:WONG, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WONG
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 1:4610 61ST ST
Mailing Address - Street 2:APT 11B
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5766
Mailing Address - Country:US
Mailing Address - Phone:646-301-5633
Mailing Address - Fax:
Practice Address - Street 1:4610 61ST ST
Practice Address - Street 2:APT 11B
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5766
Practice Address - Country:US
Practice Address - Phone:646-301-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006735-1133N00000X, 133NN1002X, 133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric