Provider Demographics
NPI:1497121917
Name:BSJ PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:BSJ PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNGJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-569-2107
Mailing Address - Street 1:150 BROADHOLLOW RD
Mailing Address - Street 2:#316
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4905
Mailing Address - Country:US
Mailing Address - Phone:516-408-0990
Mailing Address - Fax:
Practice Address - Street 1:150 BROADHOLLOW RD
Practice Address - Street 2:#316
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4905
Practice Address - Country:US
Practice Address - Phone:516-408-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032544273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1710324660Medicare NSC