Provider Demographics
NPI:1386824324
Name:NEW YORK PHYSICAL THERAPY & ACUPUNCTURE
Entity Type:Organization
Organization Name:NEW YORK PHYSICAL THERAPY & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SEONG SHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-353-3836
Mailing Address - Street 1:41-10 BOWNE ST
Mailing Address - Street 2:#L1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-353-3836
Mailing Address - Fax:718-353-3837
Practice Address - Street 1:41-10 BOWNE ST
Practice Address - Street 2:#L1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-353-3836
Practice Address - Fax:718-353-3837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK PHYSICAL THERAPY & ACUPUNCTURE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002262171100000X
NY014833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02751811Medicaid
NYX87771Medicare UPIN
NY05676Medicare PIN