Provider Demographics
NPI:1104200633
Name:TAEJIN PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:TAEJIN PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAE JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:929-373-5772
Mailing Address - Street 1:199-04 47TH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3955
Mailing Address - Country:US
Mailing Address - Phone:929-373-5772
Mailing Address - Fax:914-462-4372
Practice Address - Street 1:199-04 47TH AVE
Practice Address - Street 2:APT 1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3955
Practice Address - Country:US
Practice Address - Phone:929-373-5772
Practice Address - Fax:914-462-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty