Provider Demographics
NPI:1457698250
Name:CHUNGDAM PHYSICAL THERAPY & REHABILITATION, P.C.
Entity Type:Organization
Organization Name:CHUNGDAM PHYSICAL THERAPY & REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-685-1004
Mailing Address - Street 1:315 5TH AVE RM 1001
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6510
Mailing Address - Country:US
Mailing Address - Phone:212-685-1004
Mailing Address - Fax:212-685-1007
Practice Address - Street 1:315 5TH AVE RM 1001
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6510
Practice Address - Country:US
Practice Address - Phone:212-685-1004
Practice Address - Fax:212-685-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254812261QH0100X
NY032265261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service