Provider Demographics
NPI:1447554894
Name:YOON, TAELIM
Entity type:Individual
Prefix:MR
First Name:TAELIM
Middle Name:
Last Name:YOON
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 1:411 HIGHLAND AVE
Mailing Address - Street 2:#C4
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1361
Mailing Address - Country:US
Mailing Address - Phone:201-638-4942
Mailing Address - Fax:
Practice Address - Street 1:38 W 32ND ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3816
Practice Address - Country:US
Practice Address - Phone:212-714-1004
Practice Address - Fax:212-714-1009
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist