Provider Demographics
NPI:1780819383
Name:EASTERN PHYSICAL MEDICINE AND REHABILITATION PC
Entity Type:Organization
Organization Name:EASTERN PHYSICAL MEDICINE AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-577-6654
Mailing Address - Street 1:36 ASPEN RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3401
Mailing Address - Country:US
Mailing Address - Phone:646-577-6654
Mailing Address - Fax:347-374-6315
Practice Address - Street 1:36 ASPEN RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3401
Practice Address - Country:US
Practice Address - Phone:646-577-6654
Practice Address - Fax:347-374-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243073251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage