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Sungguk Bae

Physical Therapist in Patchogue, NY. Individual provider (NPI-1).

NPI number1043710155
StatusActive
Last updated in NPPESFeb 15, 2018

Details

NPI
1043710155
Entity type
Individual (NPI-1)
Name
Sungguk Bae
Sex
Male
Sole proprietor
No
Enumeration date
Feb 15, 2018
Last updated
Feb 15, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist041263NYYes

Practice location

21 Cleveland St
Patchogue, NY 11772-2815

Phone 631-569-9373

Mailing address

21 Cleveland St
Patchogue, NY 11772-2815

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