Provider Demographics
NPI:1205131331
Name:CHONG, JEE YOON (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:JEE YOON
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 63RD PL FL 2
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1213
Mailing Address - Country:US
Mailing Address - Phone:201-927-1581
Mailing Address - Fax:
Practice Address - Street 1:5420 63RD PL FL 2
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1213
Practice Address - Country:US
Practice Address - Phone:201-927-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015880225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation