Basic Information
| Provider Information | |||||||||
| NPI: | 1689112310 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WON | ||||||||
| FirstName: | HO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6142 219TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113642243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473017087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14714 SANFORD AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113551358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188866268 | ||||||||
| FaxNumber: | 7188864152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2017 | ||||||||
| LastUpdateDate: | 06/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 036745-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.