Provider Demographics
NPI:1831345966
Name:WONG, PAUL S (L AC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:S
Last Name:WONG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:94 SKELLY PL
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3730
Mailing Address - Country:US
Mailing Address - Phone:516-263-8190
Mailing Address - Fax:516-248-1908
Practice Address - Street 1:70-31A 108TH STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-300-8888
Practice Address - Fax:516-248-1908
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003113171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003113OtherACUPUNCTURIST