Healthcare Provider Details

I. General information

NPI: 1518403815
Provider Name (Legal Business Name): GI HYUE PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY STE 104
PARAMUS NJ
07652-3538
US

IV. Provider business mailing address

1 KALISA WAY STE 104
PARAMUS NJ
07652-3538
US

V. Phone/Fax

Practice location:
  • Phone: 201-549-8895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03799800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: