Healthcare Provider Details

I. General information

NPI: 1396181277
Provider Name (Legal Business Name): FONG LIN TJHIA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LEXINGTON AVE. 2201
NEW YORK NY
10070-0000
US

IV. Provider business mailing address

159 MADISON AVE 4 H
NEW YORK NY
10016-5428
US

V. Phone/Fax

Practice location:
  • Phone: 212-499-4720
  • Fax:
Mailing address:
  • Phone: 212-779-9367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number009612-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: