Provider Demographics
NPI:1689846784
Name:JUSEOK PARK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:JUSEOK PARK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:917-750-7722
Mailing Address - Street 1:839 58TH ST
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3679
Mailing Address - Country:US
Mailing Address - Phone:718-633-6020
Mailing Address - Fax:718-633-6015
Practice Address - Street 1:839 58TH ST
Practice Address - Street 2:#3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3679
Practice Address - Country:US
Practice Address - Phone:718-633-6020
Practice Address - Fax:718-633-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty