1659157709 NPI number — EMERALD PHYSICAL THERAPY & ACUPUNCTURE PC

Table of content: (NPI 1659157709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659157709 NPI number — EMERALD PHYSICAL THERAPY & ACUPUNCTURE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD PHYSICAL THERAPY & ACUPUNCTURE PC
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:
1659157709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2227 76TH ST APT B2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11370-1264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-923-0334
Provider Business Mailing Address Fax Number:
631-923-0335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 WALT WHITMAN RD STE 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON STATION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11746-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-923-0334
Provider Business Practice Location Address Fax Number:
631-923-0335
Provider Enumeration Date:
09/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
OH
Authorized Official First Name:
YU SHIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DPT & LAC/PRESIDENT
Authorized Official Telephone Number:
631-923-0334

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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