Provider Demographics
NPI:1912295536
Name:KWOK, TONY WAI CHEUNG (DPT)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:WAI CHEUNG
Last Name:KWOK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SMITHTOWN BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2120
Mailing Address - Country:US
Mailing Address - Phone:631-724-5433
Mailing Address - Fax:
Practice Address - Street 1:267 SMITHTOWN BLVD
Practice Address - Street 2:STE 4
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2120
Practice Address - Country:US
Practice Address - Phone:631-724-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033557225100000X, 2251S0007X
0335572251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic