Organization
154 NORTHERN MEDICAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOON MO MYUNG (OWNER)
(718) 445-0200
Entity
Organization
Contact information
Practice address
15408 NORTHERN BLVD, SUITE 2K, FLUSHING, NY 11354-5040
(718) 445-0200
Mailing address
15408 NORTHERN BLVD, SUITE 2K, FLUSHING, NY 11354-5040
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/27/2013
Last updated
08/27/2013
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