Provider Demographics
NPI:1952980195
Name:HYEONGJIN JEON PT PC
Entity type:Organization
Organization Name:HYEONGJIN JEON PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYEONGJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-225-9000
Mailing Address - Street 1:3930 RICHMOND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5103
Mailing Address - Country:US
Mailing Address - Phone:718-317-9801
Mailing Address - Fax:
Practice Address - Street 1:13440 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4796
Practice Address - Country:US
Practice Address - Phone:929-669-9899
Practice Address - Fax:718-799-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty