MEDICARE: EUGENE PARK L.AC, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	7437	NY
2	171100000X	Acupuncturist	AC8570	CA
3	171100000X	Acupuncturist	25MZ00169700	NJ
4	363A00000X	Physician Assistant	25MP00577600	NJ
5	363A00000X	Physician Assistant	PA18721	CA
6	363A00000X	Physician Assistant	025055	NY

General Provider Information

NPI Number	:	1154472546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE PARK L.AC, PA-C

Provider Business Mailing Address
First Line	:	24A E EDSALL BLVD
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-3626
Country	:	US
Telephone Number	:	323-304-4832
Fax Number	:

Provider Business Practice Location Address
First Line	:	458 WEST ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-3408
Country	:	US
Telephone Number	:	201-474-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	01/12/2024

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