Healthcare Provider Details

I. General information

NPI: 1902457740
Provider Name (Legal Business Name): SUJEONG GONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 150TH ST FL 1
FLUSHING NY
11354-4927
US

IV. Provider business mailing address

3821 150TH ST FL 1
FLUSHING NY
11354-4927
US

V. Phone/Fax

Practice location:
  • Phone: 347-827-0009
  • Fax:
Mailing address:
  • Phone: 347-827-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040084
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: