Healthcare Provider Details

I. General information

NPI: 1881312924
Provider Name (Legal Business Name): CHOHEE PARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 80TH ST
ELMHURST NY
11373-1234
US

IV. Provider business mailing address

4012 80TH ST
ELMHURST NY
11373-1234
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-9000
  • Fax: 718-961-0666
Mailing address:
  • Phone: 718-886-9000
  • Fax: 718-961-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: