Provider Demographics
NPI:1003243254
Name:NORTHERN PHYSICAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:NORTHERN PHYSICAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEUNG YI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-746-4919
Mailing Address - Street 1:15001 NORTHERN BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3896
Mailing Address - Country:US
Mailing Address - Phone:718-746-4919
Mailing Address - Fax:
Practice Address - Street 1:15001 NORTHERN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3896
Practice Address - Country:US
Practice Address - Phone:718-746-4919
Practice Address - Fax:718-746-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272293208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty