Provider Demographics
NPI:1639519663
Name:HAN, JUNGWOO (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUNGWOO
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 N MIDDLETOWN RD
Mailing Address - Street 2:STE 11
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1296
Mailing Address - Country:US
Mailing Address - Phone:845-735-8440
Mailing Address - Fax:845-735-8445
Practice Address - Street 1:300 N MIDDLETOWN RD
Practice Address - Street 2:STE 11
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1296
Practice Address - Country:US
Practice Address - Phone:845-735-8440
Practice Address - Fax:845-735-8445
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00328500213ES0103X
NY006740213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300161368Medicare PIN