Provider Demographics
NPI:1225135866
Name:ROH, SEUNG C (DC)
Entity Type:Individual
Prefix:
First Name:SEUNG
Middle Name:C
Last Name:ROH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GRAND AVE
Mailing Address - Street 2:STE 504
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1083
Mailing Address - Country:US
Mailing Address - Phone:718-353-3988
Mailing Address - Fax:718-353-9424
Practice Address - Street 1:16326 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2645
Practice Address - Country:US
Practice Address - Phone:718-353-3988
Practice Address - Fax:718-353-9424
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26923111N00000X
NJ38MC00690500111N00000X
NYX011994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor