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General NPI Number Information
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NPI Number | 1780819383
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Entity Type | Organization
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Legal Business Name | EASTERN PHYSICAL MEDICINE AND REHABILITATION PC
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 36 ASPEN RD
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City | KINGS PARK
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State | NY
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Zip | 11754-3401
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Country | US
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Telephone | 646-577-6654
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Fax | 347-374-6315
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Provider Business Mailing Address
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Address Line | 36 ASPEN RD
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City | KINGS PARK
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State | NY
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Zip | 11754-3401
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Country | US
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Telephone | 646-577-6654
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Fax | 347-374-6315
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Authorized Official
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Title or Position | PRESIDENT
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Name | YONG CHI
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Credential | MD
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Telephone | 646-577-6654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number | 243073
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License Number State | NY
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