Individual
MR. JONATHAN WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
49 CARNEGIE AVE, STATEN ISLAND, NY 10314-3819
(347) 513-1676
Mailing address
49 CARNEGIE AVE, STATEN ISLAND, NY 10314-3819
(347) 513-1676
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
302155
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
310033
NY
Other
Enumeration date
01/31/2013
Last updated
12/03/2020
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