Provider Demographics
NPI:1194369595
Name:BAE, WOOYOUNG
Entity type:Individual
Prefix:
First Name:WOOYOUNG
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 235TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1509
Mailing Address - Country:US
Mailing Address - Phone:516-440-1317
Mailing Address - Fax:718-691-4053
Practice Address - Street 1:4029 235TH ST FL 2
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1509
Practice Address - Country:US
Practice Address - Phone:516-440-1317
Practice Address - Fax:718-691-4053
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty