1023558384 NPI number — FORT WASHINGTON PARK PEDIATRICS P.C.

Table of content: ALEXANDER JAEHYUK CHOI M.D., M.P.H. (NPI 1013440221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023558384 NPI number — FORT WASHINGTON PARK PEDIATRICS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT WASHINGTON PARK PEDIATRICS P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023558384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6830 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-238-5390
Provider Business Mailing Address Fax Number:
410-238-5396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6830 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-238-5390
Provider Business Practice Location Address Fax Number:
410-238-5396
Provider Enumeration Date:
03/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
AGUILAR
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-316-7066

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D63446 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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