Healthcare Provider Details

I. General information

NPI: 1689112310
Provider Name (Legal Business Name): HO WON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7736 169TH ST LOWR LEVEL
FRESH MEADOWS NY
11366-1371
US

IV. Provider business mailing address

3621 208TH ST # 2
BAYSIDE NY
11361-1331
US

V. Phone/Fax

Practice location:
  • Phone: 631-876-2141
  • Fax:
Mailing address:
  • Phone: 347-301-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number036745-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: