Provider Demographics
NPI:1851931984
Name:LEE, JOONSUNG (PT)
Entity Type:Individual
Prefix:
First Name:JOONSUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7508 35TH AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8129
Mailing Address - Country:US
Mailing Address - Phone:347-577-2727
Mailing Address - Fax:
Practice Address - Street 1:15301 NORTHERN BLVD STE 2F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5038
Practice Address - Country:US
Practice Address - Phone:718-888-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist