Individual ProviderSamuel Sangwon YooPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address3930 Richmond Ave Ste 200, Staten Island, NY 10312-5103(646) 240-8453PECOS EnrollmentBased on the most recent information from CMS, provider Samuel Sangwon Yoo does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1891939625Provider TypeIndividualFull NameYoo, Samuel SangwonCredentialP.T.GenderMaleSole ProprietorYesEnumeration Date4/23/2009Last Updated2/21/2022Contact InformationPractice LocationPractice Address3930 Richmond Ave Ste 200, Staten Island, NY 10312-5103Phone(646) 240-8453FaxUnlisted FaxMailing LocationMailing Address3930 Richmond Ave Ste 200, Staten Island, NY 10312-5103Phone(646) 240-8453FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense025179New YorkProvider IdentifiersIDDescriptionIssuerIDG400061606DescriptionOtherIssuerMEDICARE MEMBER PTAN FOR QUEENSNew YorkIDA400026932DescriptionOtherIssuerMEDICARE MEMBER PTAN FOR BROOKLYN, STATEN ISLAND, MANHATTANNew YorkID1891939625DescriptionMedicaidIssuerUnlistedNew York