Healthcare Provider Details

I. General information

NPI: 1063957280
Provider Name (Legal Business Name): JOEL CHOI ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2016
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 166TH ST 2ND FL
FLUSHING NY
11358
US

IV. Provider business mailing address

3636 166TH ST
FLUSHING NY
11358-2008
US

V. Phone/Fax

Practice location:
  • Phone: 347-229-7258
  • Fax:
Mailing address:
  • Phone: 347-229-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003900
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003900-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: