Healthcare Provider Details

I. General information

NPI: 1154784452
Provider Name (Legal Business Name): HYO PARK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLZ FL 8
NEW YORK NY
10119-0899
US

IV. Provider business mailing address

14221 26TH AVE APT 1C
FLUSHING NY
11354-1709
US

V. Phone/Fax

Practice location:
  • Phone: 646-630-5163
  • Fax: 718-299-6797
Mailing address:
  • Phone: 347-840-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340137-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: