Provider Demographics
NPI:1588201578
Name:WOO, SUHAN
Entity Type:Individual
Prefix:MR
First Name:SUHAN
Middle Name:
Last Name:WOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 QUEENS BLVD APT 6K
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7776
Mailing Address - Country:US
Mailing Address - Phone:917-370-7307
Mailing Address - Fax:
Practice Address - Street 1:5812 QUEENS BLVD APT 6K
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7776
Practice Address - Country:US
Practice Address - Phone:917-370-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist