Provider Demographics
NPI:1942061213
Name:JEONGWOOK PT P.C.
Entity Type:Organization
Organization Name:JEONGWOOK PT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICALTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEONGWOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-460-1090
Mailing Address - Street 1:416 WHITE ROSE LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2543
Mailing Address - Country:US
Mailing Address - Phone:646-460-1090
Mailing Address - Fax:
Practice Address - Street 1:416 WHITE ROSE LN
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2543
Practice Address - Country:US
Practice Address - Phone:646-460-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy