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General NPI Number Information
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NPI Number | 1295170686
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Entity Type | Individual
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Provider Name | ISABELLA PARK D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 8900 VAN WYCK EXPY
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City | JAMAICA
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State | NY
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Zip | 11418-2832
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Country | US
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Telephone | 718-206-6914
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Fax |
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Provider Business Mailing Address
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Address Line | 26505 GRAND CENTRAL PKWY
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City | LITTLE NECK
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State | NY
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Zip | 11362-2539
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Country | US
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Telephone |
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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 | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 259224
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License Number State | NY
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