Provider Demographics
NPI:1659400562
Name:KONG, WENDY W (FNP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:W
Last Name:KONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 AVENUE OF THE AMERICAS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-1300
Mailing Address - Country:US
Mailing Address - Phone:212-891-1099
Mailing Address - Fax:212-554-3577
Practice Address - Street 1:1271 AVENUE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1300
Practice Address - Country:US
Practice Address - Phone:212-891-1099
Practice Address - Fax:212-554-3577
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23108363LF0000X, 363LF0000X
NYF334556363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400149336Medicare PIN
NYQ62717Medicare UPIN