Individual
MS. REGINA K FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1402
(718) 470-8141
Mailing address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1402
(718) 470-8141
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR17833700
NJ
163W00000X
Registered Nurse
675414
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402082
NY
Other
Enumeration date
07/08/2015
Last updated
05/03/2017
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