Provider Demographics
NPI:1831335488
Name:ONG, AILEEN (PT)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:ONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRADHURST AVE
Mailing Address - Street 2:APT 808
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3305
Mailing Address - Country:US
Mailing Address - Phone:917-503-2834
Mailing Address - Fax:
Practice Address - Street 1:147 W 35TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2110
Practice Address - Country:US
Practice Address - Phone:917-685-9334
Practice Address - Fax:917-591-8494
Is Sole Proprietor?:No
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist