Basic Information
| Provider Information | |||||||||
| NPI: | 1083869077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | MERCENITA | ||||||||
| MiddleName: | PADAMA | ||||||||
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| Credential: | P.T. | ||||||||
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| OtherLastName: | PADAMA | ||||||||
| OtherFirstName: | MERCENITA | ||||||||
| OtherMiddleName: | SALVADOR | ||||||||
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| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5147 SIMONSON ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113734273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3478375479 | ||||||||
| FaxNumber: | 3472422439 | ||||||||
| Practice Location | |||||||||
| Address1: | 3250 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104614500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | 7188235494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2008 | ||||||||
| LastUpdateDate: | 11/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 028026 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.