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General NPI Number Information
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NPI Number | 1346387198
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Entity Type | Individual
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Provider Name | CHONG H PARK MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 56-45 MAIN STREET DIVISION OF CARDIOLOGY
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-670-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 17 SUSAN LN
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City | DIX HILLS
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State | NY
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Zip | 11746-5140
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Country | US
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Telephone | 516-578-3813
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 209516
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License Number State | NY
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