Healthcare Provider Details

I. General information

NPI: 1689588824
Provider Name (Legal Business Name): ALBERT PARK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1527 149TH ST
WHITESTONE NY
11357-2550
US

IV. Provider business mailing address

1527 149TH ST
WHITESTONE NY
11357-2550
US

V. Phone/Fax

Practice location:
  • Phone: 919-200-7105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: