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NPI Code Detail

MEDICARE: DONGHYUN SEO D.P.T

MEDICARE: DONGHYUN SEO D.P.T
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
12251X0800XOrthopedic Physical Therapist038818NY

General Provider Information

NPI Number : 1407231491
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONGHYUN SEO D.P.T
Provider Business Mailing Address
First Line : 1215 BROADWAY APT 310
Second Line :
City : ASTORIA
State : NY
Zip : 11106-4896
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4332 22ND ST STE 203
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-5077
Country : US
Telephone Number : 646-450-2475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2015
Last Update Date : 10/02/2019

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