Healthcare Provider Details

I. General information

NPI: 1023100740
Provider Name (Legal Business Name): SANG IL CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 GRAND AVE
BRONX NY
10468-6905
US

IV. Provider business mailing address

379 WINDSOR RD
ENGLEWOOD NJ
07631-1424
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-2887
  • Fax: 718-733-3874
Mailing address:
  • Phone: 201-503-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number143846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: