Healthcare Provider Details

I. General information

NPI: 1295951358
Provider Name (Legal Business Name): YOUNG SOOK CHOI RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 159TH ST APT 3D
FLUSHING NY
11358-3177
US

IV. Provider business mailing address

4312 159TH ST APT 3D
FLUSHING NY
11358-3177
US

V. Phone/Fax

Practice location:
  • Phone: 917-763-5612
  • Fax:
Mailing address:
  • Phone: 917-763-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003131
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number044313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: