Basic Information
| Provider Information | |||||||||
| NPI: | 1194197921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | BEOMSEOK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 MEODOWLANDS PARKWAY | ||||||||
| Address2: | SUIT 205 | ||||||||
| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5512577015 | ||||||||
| FaxNumber: | 5512577025 | ||||||||
| Practice Location | |||||||||
| Address1: | 1ST AVE AT 16TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124202908 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2015 | ||||||||
| LastUpdateDate: | 11/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 26NJ00596800 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 363LF0000X | 26NJ00596800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.