Provider Demographics
NPI:1689099236
Name:WONG, ERICA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MADISON AVE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5424
Mailing Address - Country:US
Mailing Address - Phone:212-889-6540
Mailing Address - Fax:212-889-4987
Practice Address - Street 1:196 CANAL ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4562
Practice Address - Country:US
Practice Address - Phone:212-227-6500
Practice Address - Fax:212-227-7550
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018556225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist