Provider Demographics
NPI:1598420119
Name:WONG, KAYLA VIRGINIA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:VIRGINIA
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 1:9 LESHYK DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2181
Mailing Address - Country:US
Mailing Address - Phone:917-837-8982
Mailing Address - Fax:
Practice Address - Street 1:246 HWY 34
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2180
Practice Address - Country:US
Practice Address - Phone:732-952-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347438-01363LF0000X
NJ26NJ01201000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily