Healthcare Provider Details

I. General information

NPI: 1568882124
Provider Name (Legal Business Name): SOON OK CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 BRIDGE PLZ N APT # 2J
FORT LEE NJ
07024-5017
US

IV. Provider business mailing address

326 BRIDGE PLZ N APT # 2J
FORT LEE NJ
07024-5017
US

V. Phone/Fax

Practice location:
  • Phone: 210-870-5865
  • Fax:
Mailing address:
  • Phone: 210-870-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number547770
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number547770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: