Provider Demographics
NPI:1649757675
Name:WONG, VICKI LEIN (MSED)
Entity Type:Individual
Prefix:MISS
First Name:VICKI
Middle Name:LEIN
Last Name:WONG
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 STANTON ST APT 4N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1246
Mailing Address - Country:US
Mailing Address - Phone:917-535-3531
Mailing Address - Fax:
Practice Address - Street 1:80 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6301
Practice Address - Country:US
Practice Address - Phone:917-535-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1288971251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)