Provider Demographics
NPI:1679776355
Name:S J PAHNG MD PC
Entity type:Organization
Organization Name:S J PAHNG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAHNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-353-6835
Mailing Address - Street 1:21704 NORTHERN BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3577
Mailing Address - Country:US
Mailing Address - Phone:718-353-6835
Mailing Address - Fax:718-353-6854
Practice Address - Street 1:21704 NORTHERN BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3577
Practice Address - Country:US
Practice Address - Phone:718-353-6835
Practice Address - Fax:718-353-6854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY188371261QP3300X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05609Medicare ID - Type Unspecified
NYG10968Medicare UPIN