Provider Demographics
NPI:1184722951
Name:HAN, SUNGHO (PT)
Entity type:Individual
Prefix:MR
First Name:SUNGHO
Middle Name:
Last Name:HAN
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 1:750 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1353
Mailing Address - Country:US
Mailing Address - Phone:973-345-1312
Mailing Address - Fax:973-742-0669
Practice Address - Street 1:750 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1353
Practice Address - Country:US
Practice Address - Phone:973-345-1312
Practice Address - Fax:973-742-0669
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00982400225100000X
NY0242161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist