Healthcare Provider Details

I. General information

NPI: 1265724272
Provider Name (Legal Business Name): EUNHYE KO PT. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 FLOWER LN
JERICHO NY
11753-2312
US

IV. Provider business mailing address

42 FLOWER LN
JERICHO NY
11753-2312
US

V. Phone/Fax

Practice location:
  • Phone: 201-759-6500
  • Fax:
Mailing address:
  • Phone: 201-759-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: