Provider Demographics
NPI:1497419188
Name:LEI, BRANDON PO-KONG (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:PO-KONG
Last Name:LEI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 GANSEVOORT BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4026
Mailing Address - Country:US
Mailing Address - Phone:347-216-0010
Mailing Address - Fax:
Practice Address - Street 1:1598 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1529
Practice Address - Country:US
Practice Address - Phone:347-857-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist