Provider Demographics
NPI:1366012619
Name:JAHONG KOO PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:JAHONG KOO PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THEARPIEST
Authorized Official - Prefix:
Authorized Official - First Name:JAHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-434-1996
Mailing Address - Street 1:18802 64TH AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3808
Mailing Address - Country:US
Mailing Address - Phone:856-434-1996
Mailing Address - Fax:
Practice Address - Street 1:16110 JAMAICA AVE STE 301
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6149
Practice Address - Country:US
Practice Address - Phone:856-434-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty