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NPI Code Detail

MEDICARE: DAVID KWON DPT

MEDICARE: DAVID KWON DPT
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
1225100000XPhysical Therapist40QA01363000NJ

General Provider Information

NPI Number : 1043526338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID KWON DPT
Provider Business Mailing Address
First Line : 15 BLOOMFIELD AVENUE
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-5119
Country : US
Telephone Number : 973-744-2770
Fax Number :
Provider Business Practice Location Address
First Line : 15 BLOOMFIELD AVE
Second Line : LOWER LEVEL
City : MONTCLAIR
State : NJ
Zip : 07042-4888
Country : US
Telephone Number : 973-744-2770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2010
Last Update Date : 02/17/2016

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