MEDICARE: HYUNJIN ROH

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	225100000X	Physical Therapist	035527	NY
2	225100000X	Physical Therapist	40QA01869000	NJ
3	225100000X	Physical Therapist	296808	CA
4	225100000X	Physical Therapist	PT026977	PA

General Provider Information

NPI Number	:	1528437209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNJIN ROH

Provider Business Mailing Address
First Line	:	5725 VAN HORN ST APT 6C
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4878
Country	:	US
Telephone Number	:	646-683-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	7945 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2938
Country	:	US
Telephone Number	:	646-683-8255
Fax Number	:	888-977-5374

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	08/28/2019

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Directions to “ HYUNJIN ROH ” Practice Location

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