Healthcare Provider Details

I. General information

NPI: 1508565599
Provider Name (Legal Business Name): MILAE PARK APN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SOUTH AVE STE 201
STATEN ISLAND NY
10314-3780
US

IV. Provider business mailing address

94 OLD SHORT HILLS RD STE 403
LIVINGSTON NJ
07039-5672
US

V. Phone/Fax

Practice location:
  • Phone: 718-697-0255
  • Fax: 718-521-6151
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF422011-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: