Provider Demographics
NPI:1578822847
Name:SON, JIRAN (RPT)
Entity Type:Individual
Prefix:
First Name:JIRAN
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15301 NORTHERN BLVD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5035
Mailing Address - Country:US
Mailing Address - Phone:718-888-1641
Mailing Address - Fax:718-888-2514
Practice Address - Street 1:15301 NORTHERN BLVD
Practice Address - Street 2:SUITE 2G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5035
Practice Address - Country:US
Practice Address - Phone:718-888-1641
Practice Address - Fax:718-888-2514
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07570GMedicare PIN