Healthcare Provider Details

I. General information

NPI: 1831023522
Provider Name (Legal Business Name): CHANGHWAN JE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MAIN ST STE 310
FLUSHING NY
11354-5434
US

IV. Provider business mailing address

3127 137TH ST APT 4A
FLUSHING NY
11354-1998
US

V. Phone/Fax

Practice location:
  • Phone: 917-563-1373
  • Fax:
Mailing address:
  • Phone: 347-594-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: