Healthcare Provider Details

I. General information

NPI: 1235498387
Provider Name (Legal Business Name): SUSAN K KWON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

IV. Provider business mailing address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2830
  • Fax: 201-445-7471
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01090400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: