Provider Demographics
NPI:1487041109
Name:WONG, ALVIN K (MMSC, PA-C)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 53RD ST UNIT C2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2917
Mailing Address - Country:US
Mailing Address - Phone:718-304-1050
Mailing Address - Fax:
Practice Address - Street 1:821 53RD ST UNIT C2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2917
Practice Address - Country:US
Practice Address - Phone:718-304-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019509-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical