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General NPI Number Information
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NPI Number | 1699144352
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Entity Type | Individual
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Provider Name | JAEMIN PARK
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Gender | Male
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 2 COMET RD
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City | SYOSSET
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State | NY
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Zip | 11791-6909
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Country | US
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Telephone | 516-470-1826
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Fax | 516-470-1827
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Provider Business Mailing Address
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Address Line | 8733 JUSTICE AVE APT 1
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City | ELMHURST
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State | NY
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Zip | 11373-4672
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Country | US
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Telephone | 585-216-3264
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 037612
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License Number State | NY
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