Provider Demographics
NPI:1952669681
Name:JIRAN SON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:JIRAN SON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:718-888-1641
Mailing Address - Street 1:15301 NORTHERN BLVD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5035
Mailing Address - Country:US
Mailing Address - Phone:718-888-1641
Mailing Address - Fax:718-888-2514
Practice Address - Street 1:15301 NORTHERN BLVD
Practice Address - Street 2:SUITE 2G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5035
Practice Address - Country:US
Practice Address - Phone:718-888-1641
Practice Address - Fax:718-888-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07570Medicare PIN