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General NPI Number Information
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NPI Number | 1508677873
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Entity Type | Organization
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Legal Business Name | KEYSTONE MEDICAL PC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 21333 39TH AVE STE 248
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City | BAYSIDE
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State | NY
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Zip | 11361-2092
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Country | US
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Telephone | 718-428-5333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 605043
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City | BAYSIDE
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State | NY
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Zip | 11360-5043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WON SOHN
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Credential |
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Telephone | 718-428-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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