Provider Demographics
NPI:1003830944
Name:CHOI, POYOON (PHD)
Entity Type:Individual
Prefix:
First Name:POYOON
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FLAMINGO RD N
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2606
Mailing Address - Country:US
Mailing Address - Phone:516-603-6323
Mailing Address - Fax:
Practice Address - Street 1:8635 QUEENS BLVD
Practice Address - Street 2:1E
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4434
Practice Address - Country:US
Practice Address - Phone:718-205-4544
Practice Address - Fax:718-205-5594
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0281ELOtherGHI MEDICARE
NY02246257Medicaid
NY0281EMOtherGHI MEDICARE
NY0281ENOtherGHI MEDICARE
NY02246257Medicaid