Provider Demographics
NPI:1255972915
Name:AN, SANGHYOP (PT, DPT)
Entity type:Individual
Prefix:
First Name:SANGHYOP
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 35TH ST APT A2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2240
Mailing Address - Country:US
Mailing Address - Phone:718-316-7238
Mailing Address - Fax:
Practice Address - Street 1:158 LINWOOD PLZ STE 219
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3704
Practice Address - Country:US
Practice Address - Phone:201-461-9333
Practice Address - Fax:201-461-0851
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043326225100000X
NJ40QA01893800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist