Provider Demographics
NPI:1023100740
Name:CHOI, SANG IL (MD)
Entity type:Individual
Prefix:
First Name:SANG
Middle Name:IL
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1424
Mailing Address - Country:US
Mailing Address - Phone:201-503-0434
Mailing Address - Fax:
Practice Address - Street 1:2271 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6905
Practice Address - Country:US
Practice Address - Phone:718-584-2887
Practice Address - Fax:718-733-3874
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY108907OtherWELL CARE
NY143846-B19OtherHEALTH FIRST
NY040426024410OtherFIDELIS
NY143846OtherHIP
NYP469881OtherOXFORD
NY00590987Medicaid
NY143846-B19OtherHEALTH FIRST