Provider Demographics
NPI:1265724272
Name:KO, EUNHYE (PT PHD)
Entity type:Individual
Prefix:
First Name:EUNHYE
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:PT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2312
Mailing Address - Country:US
Mailing Address - Phone:201-759-6500
Mailing Address - Fax:
Practice Address - Street 1:42-12, 164TH ST 1FL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-701-5500
Practice Address - Fax:718-888-1524
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03651838Medicaid