Healthcare Provider Details

I. General information

NPI: 1124763248
Provider Name (Legal Business Name): EUNJEONG CHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 48TH AVE
CORONA NY
11368-2955
US

IV. Provider business mailing address

10811 48TH AVE
CORONA NY
11368-2955
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-8918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103405
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: