Provider Demographics
NPI:1912161431
Name:HONG, JUSTIN SUP (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:SUP
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:1135 OLDE W CHOCOLATE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9188
Practice Address - Country:US
Practice Address - Phone:717-531-7010
Practice Address - Fax:717-531-7102
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8301941-1205208100000X
PAMD4427052081P0301X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026286140002Medicaid
PA1026286140002Medicaid