Healthcare Provider Details

I. General information

NPI: 1902242571
Provider Name (Legal Business Name): PRECIOUS BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42-65 KISSENA BLVD.
FLUSHING NY
11355
US

IV. Provider business mailing address

69-14 183RD ST. FRESH MEADOWS
NEW YORK NY
11365
US

V. Phone/Fax

Practice location:
  • Phone: 917-362-2018
  • Fax:
Mailing address:
  • Phone: 917-362-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number017967
License Number StateNY

VIII. Authorized Official

Name: MR. MUN S SHIEH
Title or Position: PRESIDENT
Credential: OTR
Phone: 917-362-2018