MEDICARE: CHUNG PARK M.D.

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	207L00000X	Anesthesiology Physician	140413	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00120327	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447291919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUNG PARK M.D.

Provider Business Mailing Address
First Line	:	23 LYONS RD
Second Line	:
City	:	ARMONK
State	:	NY
Zip	:	10504-2227
Country	:	US
Telephone Number	:	914-273-6988
Fax Number	:	877-464-4042

Provider Business Practice Location Address
First Line	:	23 LYONS RD
Second Line	:
City	:	ARMONK
State	:	NY
Zip	:	10504-2227
Country	:	US
Telephone Number	:	914-273-6988
Fax Number	:	877-464-4042

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/01/2018

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Directions to “ CHUNG PARK M.D.” Practice Location

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