Active NPI
Lina Mary Wongso, LPN
- Licensed Practical Nurse
- Long Island City, NY
National Provider Identifier
1407572100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 336222-01
- Practice address
- 3711 Queens Blvd
Long Island City, NY 11101-1725 - Phone
- (718) 606-3863
- NPI assigned
- Oct 13, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 336222-01 | NY | Primary |
Addresses
Primary practice location
3711 Queens Blvd
Long Island City, NY 11101-1725
Mailing address
13915 83Rd Ave Apt 419
Briarwood, NY 11435-1508
Phone (631) 507-8298
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 336222-01 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665619200000",
"number": "1407572100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13915 83RD AVE APT 419",
"city": "BRIARWOOD",
"state": "NY",
"postal_code": "114351508",
"telephone_number": "631-507-8298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3711 QUEENS BLVD",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111011725",
"telephone_number": "718-606-3863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONGSO",
"first_name": "LINA",
"middle_name": "MARY",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-13",
"last_updated": "2022-10-13",
"certification_date": "2022-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "336222-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.