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General NPI Number Information
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NPI Number | 1942061213
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Entity Type | Organization
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Legal Business Name | JEONGWOOK PT P.C.
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 416 WHITE ROSE LN
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City | EAST MEADOW
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State | NY
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Zip | 11554-2543
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Country | US
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Telephone | 646-460-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 416 WHITE ROSE LN
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City | EAST MEADOW
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State | NY
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Zip | 11554-2543
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Country | US
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Telephone | 646-460-1090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICALTHERAPIST
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Name | JEONGWOOK SO
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Credential | PT
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Telephone | 646-460-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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