Provider Demographics
NPI:1659023448
Name:WONG, MITCHELL J (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:J
Last Name:WONG
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1966
Mailing Address - Country:US
Mailing Address - Phone:917-363-0793
Mailing Address - Fax:
Practice Address - Street 1:13626 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6533
Practice Address - Country:US
Practice Address - Phone:718-886-1200
Practice Address - Fax:212-226-2289
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse