Provider Demographics
NPI:1841720950
Name:JWC PT PC
Entity type:Organization
Organization Name:JWC PT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAEWOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-256-1455
Mailing Address - Street 1:20935 NORTHERN BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3134
Mailing Address - Country:US
Mailing Address - Phone:718-225-9000
Mailing Address - Fax:718-352-9000
Practice Address - Street 1:20935 NORTHERN BLVD STE 215
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3134
Practice Address - Country:US
Practice Address - Phone:718-225-9000
Practice Address - Fax:718-352-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty