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General NPI Number Information
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NPI Number | 1609118843
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Entity Type | Individual
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Provider Name | SUE JUNG PARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 480 RED HILL RD
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3052
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Country | US
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Telephone | 848-225-6566
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Fax |
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Provider Business Mailing Address
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Address Line | 480 RED HILL RD
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3052
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Country | US
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Telephone | 848-225-6566
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 25MA10582100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 298879-01
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License Number State | NY
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