Healthcare Provider Details

I. General information

NPI: 1215137971
Provider Name (Legal Business Name): YOUNG SEOK PARK P.T. & L, AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 GRAND AVE.
BALDWIN NY
11510
US

IV. Provider business mailing address

15 WILDWOOD LN
GREENVALE NY
11548
US

V. Phone/Fax

Practice location:
  • Phone: 516-623-2277
  • Fax: 516-623-2525
Mailing address:
  • Phone: 516-623-2277
  • Fax: 516-623-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002591
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: