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General NPI Number Information
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NPI Number | 1821588120
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Entity Type | Organization
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Legal Business Name | NORTHERN INERVENTIONAL MEDICAL LLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 15001 NORTHERN BLVD FL 1
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City | FLUSHING
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State | NY
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Zip | 11354-3896
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Country | US
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Telephone | 201-917-3455
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Fax | 866-461-8194
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Provider Business Mailing Address
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Address Line | PO BOX 1791
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-1191
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Country | US
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Telephone | 201-917-3455
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Fax | 866-461-8194
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Authorized Official
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Title or Position | OWNER
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Name | JOHN S CHO
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Credential | MD
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Telephone | 201-960-4259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 253261
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License Number State | NY
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