Healthcare Provider Details

I. General information

NPI: 1730631466
Provider Name (Legal Business Name): HYEYOUNG PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

319 HILLSIDE AVE
LEONIA NJ
07605-1619
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-4876
  • Fax:
Mailing address:
  • Phone: 917-623-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00580000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: