Healthcare Provider Details

I. General information

NPI: 1710373220
Provider Name (Legal Business Name): 2080 PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 58TH STREET SUITE 510
NEW YORK NY
10019-1819
US

IV. Provider business mailing address

330 W 58TH STREET SUITE 510
NEW YORK NY
10019-1819
US

V. Phone/Fax

Practice location:
  • Phone: 212-245-2122
  • Fax: 212-245-2112
Mailing address:
  • Phone: 212-245-2122
  • Fax: 212-245-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032831
License Number StateNY

VIII. Authorized Official

Name: MR. SEONGYONG HEO
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 917-600-0189