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General NPI Number Information
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NPI Number | 1992944524
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Entity Type | Organization
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Legal Business Name | NORTHERN COMMUNITY MEDICAL PC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 4522 162ND ST
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City | FLUSHING
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State | NY
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Zip | 11358-3280
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Country | US
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Telephone | 718-463-0101
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Fax | 718-460-2009
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Provider Business Mailing Address
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Address Line | 235 WYCKOFF AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-5303
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Country | US
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Telephone | 718-463-0101
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Fax | 718-460-2009
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WON CHO
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Credential | M.D.
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Telephone | 718-463-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 136789
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License Number State | NY
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