Provider Demographics
NPI:1447560537
Name:CO, AILEEN ONG (PT)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:ONG
Last Name:CO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 62ND ST
Mailing Address - Street 2:3RD FL
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3632
Mailing Address - Country:US
Mailing Address - Phone:646-704-5675
Mailing Address - Fax:
Practice Address - Street 1:3920 62ND ST
Practice Address - Street 2:3RD FL
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3632
Practice Address - Country:US
Practice Address - Phone:646-704-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031066-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist