Provider Demographics
NPI:1740634542
Name:CHOI, JONG WON (DPM)
Entity type:Individual
Prefix:
First Name:JONG WON
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RACHEL AVE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3310
Mailing Address - Country:US
Mailing Address - Phone:347-997-0485
Mailing Address - Fax:
Practice Address - Street 1:614 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4802
Practice Address - Country:US
Practice Address - Phone:347-997-0485
Practice Address - Fax:718-599-3366
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006966213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty