Provider Demographics
NPI:1245849397
Name:HAENGYEOL HEO PT PC
Entity type:Organization
Organization Name:HAENGYEOL HEO PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT
Authorized Official - Prefix:
Authorized Official - First Name:HAENGYEOL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-799-0180
Mailing Address - Street 1:127 SANTA BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5828
Mailing Address - Country:US
Mailing Address - Phone:347-379-5172
Mailing Address - Fax:
Practice Address - Street 1:14015 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3433
Practice Address - Country:US
Practice Address - Phone:347-379-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty