Healthcare Provider Details

I. General information

NPI: 1205473774
Provider Name (Legal Business Name): NEW CORE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 235TH ST FL 2
DOUGLASTON NY
11363-1509
US

IV. Provider business mailing address

4029 235TH ST FL 2
DOUGLASTON NY
11363-1509
US

V. Phone/Fax

Practice location:
  • Phone: 718-359-1004
  • Fax: 718-281-4402
Mailing address:
  • Phone: 718-359-1004
  • Fax: 718-281-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: WOOYOUNG BAE
Title or Position: PRESIDENT
Credential:
Phone: 718-281-4400