Healthcare Provider Details

I. General information

NPI: 1992463848
Provider Name (Legal Business Name): NAYOUNG PARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 08/10/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 FORT WASHINGTON AVENUE HEART CENTER 4TH FL
NEW YORK NY
10032
US

IV. Provider business mailing address

173 FORT WASHINGTON AVENUE HEART CENTER 4TH FL
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-7600
  • Fax:
Mailing address:
  • Phone: 212-305-7600
  • Fax: 212-305-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: