Provider Demographics
NPI:1114182219
Name:JASON SZEPOK KONG DO PC
Entity Type:Organization
Organization Name:JASON SZEPOK KONG DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SZEPOK
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-551-1401
Mailing Address - Street 1:3901 MAIN ST
Mailing Address - Street 2:309
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5432
Mailing Address - Country:US
Mailing Address - Phone:718-886-2906
Mailing Address - Fax:718-301-1775
Practice Address - Street 1:3901 MAIN ST
Practice Address - Street 2:309
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5432
Practice Address - Country:US
Practice Address - Phone:718-886-2906
Practice Address - Fax:718-301-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246399261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation