Provider Demographics
NPI:1700011921
Name:CORE CARE PHYSICAL THERAPY AND ACUPUNCTURE,PLLC
Entity Type:Organization
Organization Name:CORE CARE PHYSICAL THERAPY AND ACUPUNCTURE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JI WON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:914-902-0200
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-0227
Mailing Address - Country:US
Mailing Address - Phone:914-902-0200
Mailing Address - Fax:
Practice Address - Street 1:2 N BROADWAY
Practice Address - Street 2:T2
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2309
Practice Address - Country:US
Practice Address - Phone:914-902-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002753171100000X
NY021333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty