Healthcare Provider Details

I. General information

NPI: 1134767197
Provider Name (Legal Business Name): SEUNGYOUNG HAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 215TH ST FL 1
BAYSIDE NY
11361-2973
US

IV. Provider business mailing address

4324 215TH ST FL 1
BAYSIDE NY
11361-2973
US

V. Phone/Fax

Practice location:
  • Phone: 516-537-9639
  • Fax: 516-985-7850
Mailing address:
  • Phone: 516-537-9639
  • Fax: 516-985-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: