=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437060274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUNGHEE PARK CNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2026
-----------------------------------------------------
Last Update Date | 09/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 532 N FARVIEW AVE
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-265-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1859 E MAIN ST
-----------------------------------------------------
City | MOHEGAN LAKE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10547-1287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-562-7036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | NA200049790
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------