Healthcare Provider Details

I. General information

NPI: 1194197921
Provider Name (Legal Business Name): BEOMSEOK OH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVE AT 16TH ST
NEW YORK NY
10003
US

IV. Provider business mailing address

38 MEODOWLANDS PARKWAY SUIT 205
SECAUCUS NJ
07094
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2908
  • Fax:
Mailing address:
  • Phone: 551-257-7015
  • Fax: 551-257-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26NJ00596800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00596800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: