Provider Demographics
NPI:1295992014
Name:YOUNGS PHYSICAL THERAPY P C
Entity type:Organization
Organization Name:YOUNGS PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LAC
Authorized Official - Phone:718-352-8010
Mailing Address - Street 1:1417 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1211
Mailing Address - Country:US
Mailing Address - Phone:718-352-8010
Mailing Address - Fax:718-352-8012
Practice Address - Street 1:1417 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1211
Practice Address - Country:US
Practice Address - Phone:718-352-8010
Practice Address - Fax:718-352-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03477171100000X
NY16067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02762316Medicaid
NY05417Medicare PIN