Provider Demographics
NPI:1669859492
Name:NAMYOUNG BAEK PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:NAMYOUNG BAEK PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NAMYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-267-8990
Mailing Address - Street 1:3508 154TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5020
Mailing Address - Country:US
Mailing Address - Phone:929-300-7109
Mailing Address - Fax:347-506-0127
Practice Address - Street 1:3508 154TH ST FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5020
Practice Address - Country:US
Practice Address - Phone:929-300-7109
Practice Address - Fax:347-506-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036349261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy