Healthcare Provider Details

I. General information

NPI: 1841119237
Provider Name (Legal Business Name): HYEWON PARK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 12TH ST APT 906
PALISADES PARK NJ
07650-2086
US

IV. Provider business mailing address

600 12TH ST APT 906
PALISADES PARK NJ
07650-2086
US

V. Phone/Fax

Practice location:
  • Phone: 732-770-5345
  • Fax:
Mailing address:
  • Phone: 732-770-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002508
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF422000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: