Healthcare Provider Details

I. General information

NPI: 1003501982
Provider Name (Legal Business Name): YOUNGSIK JEONG L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 E TREMONT AVE
BRONX NY
10461-5726
US

IV. Provider business mailing address

19780F PECK AVE
FRESH MEADOWS NY
11365-2878
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-0818
  • Fax:
Mailing address:
  • Phone: 929-383-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055493-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: