Individual
LORETTA WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706
(917) 609-7898
Mailing address
301 E MAIN ST BLDG 211, BAY SHORE, NY 11706-8408
(631) 675-4550
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
340267
NY
Other
Enumeration date
10/19/2017
Last updated
01/06/2020
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