MEDICARE: POYOON CHOI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	15092	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0281EL	OTHER	NY	GHI MEDICARE
3	0281EM	OTHER	NY	GHI MEDICARE
4	0281EN	OTHER	NY	GHI MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003830944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POYOON CHOI PH.D.

Provider Business Mailing Address
First Line	:	44 FLAMINGO RD N
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-2606
Country	:	US
Telephone Number	:	516-603-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 QUEENS BLVD
Second Line	:	1E
City	:	ELMHURST
State	:	NY
Zip	:	11373-4434
Country	:	US
Telephone Number	:	718-205-4544
Fax Number	:	718-205-5594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/06/2012

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Directions to “ POYOON CHOI PH.D.” Practice Location

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