=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487985974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOON J PARK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2010
-----------------------------------------------------
Last Update Date | 01/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1772 SOUTH RD
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-7417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-298-6060
-----------------------------------------------------
Fax | 845-913-9101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1772 SOUTH RD
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-7417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-298-6060
-----------------------------------------------------
Fax | 845-913-9101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JANE H PARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-242-0117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------