Healthcare Provider Details

I. General information

NPI: 1780336222
Provider Name (Legal Business Name): TERRENCE S PARK PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 JUNCTION BLVD
ELMHURST NY
11373-5156
US

IV. Provider business mailing address

5910 JUNCTION BLVD
ELMHURST NY
11373-5156
US

V. Phone/Fax

Practice location:
  • Phone: 201-916-0735
  • Fax:
Mailing address:
  • Phone: 201-916-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: TERRENCE PARK
Title or Position: PODIATRIST
Credential:
Phone: 201-916-0735