Provider Demographics
NPI:1598376121
Name:WONG, ANGELICA OI-LING (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:OI-LING
Last Name:WONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1430
Mailing Address - Country:US
Mailing Address - Phone:201-736-0537
Mailing Address - Fax:
Practice Address - Street 1:519 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3713
Practice Address - Country:US
Practice Address - Phone:201-354-1684
Practice Address - Fax:201-354-2535
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01941900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist