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General NPI Number Information
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NPI Number | 1073629200
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Entity Type | Individual
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Provider Name | CHONGHYO THOMAS PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 44 SYLVAN AVE SUITE 2C
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2426
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Country | US
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Telephone | 201-242-1002
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Fax | 201-242-1012
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Provider Business Mailing Address
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Address Line | 32 PRISCILLA LN
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2328
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Country | US
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Telephone | 201-541-7713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA68348
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 187394-1
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License Number State | NY
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