Active NPI
Ki Hyun Chong, MPT
- Physical Therapist
- Palisades Park, NJ
National Provider Identifier
1669651394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 62 022569
- Practice address
- 280 Grand Ave
3A
Palisades Park, NJ 07650-1167 - Phone
- (917) 270-4275
- NPI assigned
- Oct 30, 2007
- Last updated
- Feb 2, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 62 022569 | NY | Primary |
Addresses
Primary practice location
280 Grand Ave
3A
Palisades Park, NJ 07650-1167
Mailing address
52 Hickory Hill CT
07866
Rockaway, NJ 07866-4821
Phone (347) 638-4735
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120515000474 | NY | Practitioner - Physical Therapist in Private Practice | 9436312279 | Practice locations: River Edge, NJ |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62 022569 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485993600000",
"number": "1669651394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 HICKORY HILL CT",
"address_2": "07866",
"city": "ROCKAWAY",
"state": "NJ",
"postal_code": "078664821",
"telephone_number": "347-638-4735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 GRAND AVE",
"address_2": "3A",
"city": "PALISADES PARK",
"state": "NJ",
"postal_code": "076501167",
"telephone_number": "917-270-4275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHONG",
"first_name": "KI HYUN",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-30",
"last_updated": "2017-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "62 022569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palisades Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.