Provider Demographics
NPI:1700239258
Name:HEO, HAENGYEOL
Entity Type:Individual
Prefix:
First Name:HAENGYEOL
Middle Name:
Last Name:HEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DOUGHTY BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1357
Mailing Address - Country:US
Mailing Address - Phone:516-758-7208
Mailing Address - Fax:
Practice Address - Street 1:420 DOUGHTY BLVD STE 218
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1357
Practice Address - Country:US
Practice Address - Phone:516-758-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist