Healthcare Provider Details

I. General information

NPI: 1518111889
Provider Name (Legal Business Name): SUSAN HING KEUNG P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21619 31ST RD
BAYSIDE NY
11360-2802
US

IV. Provider business mailing address

21619 31ST RD
BAYSIDE NY
11360-2802
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-2665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number016676-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: