Healthcare Provider Details

I. General information

NPI: 1821086216
Provider Name (Legal Business Name): STEVEN PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WOODSTOWN RD
SALEM NJ
08079-2064
US

IV. Provider business mailing address

227 LAUREL RD SUITE 300
VOORHEES NJ
08043-8303
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-6700
  • Fax: 856-935-6772
Mailing address:
  • Phone: 856-770-3044
  • Fax: 856-770-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA02513800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: