Provider Demographics
NPI:1679863385
Name:WONG, KAREN BETH (DPT)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:BETH
Last Name:WONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 SOTZEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3224
Mailing Address - Country:US
Mailing Address - Phone:646-796-6452
Mailing Address - Fax:
Practice Address - Street 1:141 MARK TREE RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2221
Practice Address - Country:US
Practice Address - Phone:631-467-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist