Healthcare Provider Details

I. General information

NPI: 1164276481
Provider Name (Legal Business Name): WELLNESS PHYSICAL THERAPY & ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUJEONG GONG
Title or Position: DPT, LAC
Credential: DPT, LAC
Phone: 347-827-0009