Provider Demographics
NPI:1013405232
Name:JUNG, CONNIE SEHEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SEHEE
Last Name:JUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 42ND RD APT 17B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4138
Mailing Address - Country:US
Mailing Address - Phone:714-515-2378
Mailing Address - Fax:
Practice Address - Street 1:2703 42ND RD APT 17B
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4138
Practice Address - Country:US
Practice Address - Phone:714-515-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022373225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYHX0007011522Medicaid