Provider Demographics
NPI:1275864159
Name:CHOE-BAEK, SU CHONG (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:CHONG
Last Name:CHOE-BAEK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 61ST ST
Mailing Address - Street 2:#402
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2234
Mailing Address - Country:US
Mailing Address - Phone:646-239-0117
Mailing Address - Fax:
Practice Address - Street 1:3330 61ST ST
Practice Address - Street 2:#402
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2234
Practice Address - Country:US
Practice Address - Phone:646-239-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0142762083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine