Provider Demographics
NPI:1841591153
Name:J.S.K. MEDICAL PC
Entity type:Organization
Organization Name:J.S.K. MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB-SUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KEUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-892-9432
Mailing Address - Street 1:10248 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2434
Mailing Address - Country:US
Mailing Address - Phone:718-779-1900
Mailing Address - Fax:718-803-1629
Practice Address - Street 1:947 COLUMBUS AVE
Practice Address - Street 2:3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3108
Practice Address - Country:US
Practice Address - Phone:917-892-9432
Practice Address - Fax:877-721-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227598204D00000X, 207QG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty