Provider Demographics
NPI:1043878382
Name:CHUNG, JONATHAN (OTR/L)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ELM DR N
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5500
Mailing Address - Country:US
Mailing Address - Phone:646-318-7961
Mailing Address - Fax:
Practice Address - Street 1:102 ELM DR N
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5500
Practice Address - Country:US
Practice Address - Phone:646-318-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist