Basic Information
| Provider Information | |||||||||
| NPI: | 1710364286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOE | ||||||||
| FirstName: | SEONG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 MICHAEL PL FL 1 | ||||||||
| Address2: | |||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113601169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473062345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 529 BEACH 20TH ST | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183277307 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F338883-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 612746-1 | NY | N | Nursing Service Providers | Registered Nurse |
No ID Information.