Provider Demographics
NPI:1548409360
Name:CHUNG, JEFFREY (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13438 BLOSSOM AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4639
Mailing Address - Country:US
Mailing Address - Phone:347-326-2511
Mailing Address - Fax:
Practice Address - Street 1:11 MONROE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7386
Practice Address - Country:US
Practice Address - Phone:212-962-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist