Healthcare Provider Details

I. General information

NPI: 1679157747
Provider Name (Legal Business Name): TIMOTHY JAEHYUN CHOI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

185 S ORANGE AVE RM I-506
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6609
  • Fax:
Mailing address:
  • Phone: 973-972-4595
  • Fax: 973-972-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number344119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: