Basic Information
| Provider Information | |||||||||
| NPI: | 1922108182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOI | ||||||||
| FirstName: | JONG-JIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 ROUTE 25A | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117871431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623413 | ||||||||
| FaxNumber: | 6318623604 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 ROUTE 25A | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117871431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623413 | ||||||||
| FaxNumber: | 6318623604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207L00000X | 121410-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00227610 | 05 | NY | MEDICAID |