Provider Demographics
NPI:1992436117
Name:BAN PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:BAN PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MYEONGJI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-423-8053
Mailing Address - Street 1:290 MADISON AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6308
Mailing Address - Country:US
Mailing Address - Phone:224-423-8053
Mailing Address - Fax:973-915-7116
Practice Address - Street 1:290 MADISON AVE STE 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6308
Practice Address - Country:US
Practice Address - Phone:224-423-8053
Practice Address - Fax:973-915-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty