Basic Information
| Provider Information | |||||||||
| NPI: | 1871507095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14116 25TH RD | ||||||||
| Address2: | 4D | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113541261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176874463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 W END AVE | ||||||||
| Address2: | 1C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100253533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518100 | ||||||||
| FaxNumber: | 2129320964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4723 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 02064464 | 05 | NY | MEDICAID | 0281EC | 01 | NY | MEDICARE GHI | OTHER |