Provider Demographics
NPI:1578531521
Name:KORO, EUGENE (DPT)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:KORO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 OCEAN PKWY
Mailing Address - Street 2:UNIT 5 - G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7748
Mailing Address - Country:US
Mailing Address - Phone:718-616-0026
Mailing Address - Fax:347-374-4496
Practice Address - Street 1:726 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6322
Practice Address - Country:US
Practice Address - Phone:718-616-0026
Practice Address - Fax:347-374-4496
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02209218Medicaid
NYA100001026Medicare PIN