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General NPI Number Information
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NPI Number | 1902242571
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Entity Type | Organization
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Legal Business Name | PRECIOUS BODY LLC
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 42-65 KISSENA BLVD.
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 917-362-2018
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Fax |
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Provider Business Mailing Address
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Address Line | 69-14 183RD ST. FRESH MEADOWS
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City | NEW YORK
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State | NY
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Zip | 11365
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Country | US
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Telephone | 917-362-2018
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MUN S SHIEH
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Credential | OTR
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Telephone | 917-362-2018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 017967
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License Number State | NY
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