Healthcare Provider Details

I. General information

NPI: 1104748029
Provider Name (Legal Business Name): SEO YOUNG ESTHER PARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MIDLAND AVE
NYACK NY
10960-1912
US

IV. Provider business mailing address

455 FAIRVIEW AVE APT 12
FAIRVIEW NJ
07022-1865
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-2000
  • Fax:
Mailing address:
  • Phone: 201-704-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number072045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: