Provider Demographics
NPI:1417947664
Name:CHO, CHOONG YUL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHOONG
Middle Name:YUL
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 CARLLS STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8017
Mailing Address - Country:US
Mailing Address - Phone:631-667-4200
Mailing Address - Fax:631-667-4243
Practice Address - Street 1:1162 CARLLS STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8017
Practice Address - Country:US
Practice Address - Phone:631-667-4200
Practice Address - Fax:631-667-4243
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1214032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00696268Medicaid
NY00696268Medicaid
320043Medicare ID - Type Unspecified