Provider Demographics
NPI:1629105754
Name:HONG, JUWAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JUWAN
Middle Name:
Last Name:HONG
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 1:15408 NORTHERN BLVD
Mailing Address - Street 2:2F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5040
Mailing Address - Country:US
Mailing Address - Phone:718-939-1275
Mailing Address - Fax:718-939-1277
Practice Address - Street 1:15408 NORTHERN BLVD
Practice Address - Street 2:2F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5040
Practice Address - Country:US
Practice Address - Phone:718-939-1275
Practice Address - Fax:718-939-1277
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2203391OtherUNITED HEALTHCARE
NY02449296Medicaid
NY02449296Medicaid
NY2203391OtherUNITED HEALTHCARE