Healthcare Provider Details

I. General information

NPI: 1073076568
Provider Name (Legal Business Name): BONGYONG CHOI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24825 NORTHERN BLVD STE 2B
LITTLE NECK NY
11362-1280
US

IV. Provider business mailing address

24825 NORTHERN BLVD STE 2B
LITTLE NECK NY
11362-1280
US

V. Phone/Fax

Practice location:
  • Phone: 347-235-4742
  • Fax: 718-691-4366
Mailing address:
  • Phone: 909-567-3870
  • Fax: 718-691-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: