Healthcare Provider Details

I. General information

NPI: 1326307588
Provider Name (Legal Business Name): JENNIFER PARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ZATORSKI MD

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

685 WHITE PLAINS RD
EASTCHESTER NY
10709-5545
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-7228
  • Fax: 717-544-4149
Mailing address:
  • Phone: 914-787-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT201313
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD454020
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number288069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: