| Samuel Yoo Physical Therapy Pc | |
|
3930 Richmond Ave Ste 200 Staten Island NY 10312-5103 | |
| (718) 317-9801 | |
| Not Available |
| Full Name | Samuel Yoo Physical Therapy Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3930 Richmond Ave Ste 200, Staten Island, New York |
| Authorized Official Name and Position | Samuel Yoo (PT) |
| Authorized Official Contact | 6462408453 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel Yoo Physical Therapy Pc 3930 Richmond Ave Ste 200 Staten Island NY 10312-5103 Ph: () - | Samuel Yoo Physical Therapy Pc 3930 Richmond Ave Ste 200 Staten Island NY 10312-5103 Ph: (718) 317-9801 |
| NPI Number | 1124773940 |
|---|---|
| Provider Enumeration Date | 02/21/2022 |
| Last Update Date | 06/22/2023 |
| Medicare PECOS PAC ID | 8921493990 |
|---|---|
| Medicare Enrollment ID | O20220310000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124773940 | NPI | - | NPPES |
| G400061606 | Other | NY | MEDICARE MEMBER PTAN FOR QUEENS |
| A400026932 | Other | NY | MEDICARE MEMBER PTAN FOR BROOKLYN, STATEN ISLAND, MANHATTAN |
| 1891939625 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Samuel Sangwon Yoo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891939625 PECOS PAC ID: 0345370300 Enrollment ID: I20100810000556 |
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