Healthcare Provider Details

I. General information

NPI: 1457064784
Provider Name (Legal Business Name): GOGO PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 EASTCHESTER RD STE 204
BRONX NY
10469-5950
US

IV. Provider business mailing address

109 CANDY LN
SYOSSET NY
11791-4911
US

V. Phone/Fax

Practice location:
  • Phone: 347-843-6230
  • Fax:
Mailing address:
  • Phone: 718-757-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KIM
Title or Position: PRESIDENT
Credential: PT
Phone: 718-757-8292