Provider Demographics
NPI:1548583016
Name:JO, MYEONG
Entity type:Individual
Prefix:MR
First Name:MYEONG
Middle Name:
Last Name:JO
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 1:2926 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2201
Mailing Address - Country:US
Mailing Address - Phone:718-359-3373
Mailing Address - Fax:718-321-8647
Practice Address - Street 1:2926 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2201
Practice Address - Country:US
Practice Address - Phone:718-359-3373
Practice Address - Fax:718-321-8647
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045516183500000X
NJ28RI03180100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist