Provider Demographics
NPI:1760759336
Name:JEN, PEI-TSUNG
Entity Type:Individual
Prefix:MS
First Name:PEI-TSUNG
Middle Name:
Last Name:JEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22227 41ST RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2449
Mailing Address - Country:US
Mailing Address - Phone:718-423-1966
Mailing Address - Fax:
Practice Address - Street 1:5637 188TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2230
Practice Address - Country:US
Practice Address - Phone:718-357-4650
Practice Address - Fax:718-357-3507
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009647-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist