Provider Demographics
NPI:1902229107
Name:KOH, EUN JU
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:JU
Last Name:KOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:EUN JU
Other - Last Name:KOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21 BLOOMINGDALE ROAD
Mailing Address - Street 2:ROGERS BUILDING- CENTER FOR AUTISM AND THE DEVELOPING B
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605
Mailing Address - Country:US
Mailing Address - Phone:914-997-5848
Mailing Address - Fax:914-997-8626
Practice Address - Street 1:21 BLOOMINGDALE ROAD
Practice Address - Street 2:ROGERS BUILDING- CADB
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605
Practice Address - Country:US
Practice Address - Phone:914-997-5848
Practice Address - Fax:914-997-8626
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12458103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst