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General NPI Number Information
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NPI Number | 1821086216
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Entity Type | Individual
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Provider Name | STEVEN PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 310 WOODSTOWN RD
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City | SALEM
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State | NJ
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Zip | 08079-2064
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Country | US
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Telephone | 856-935-6700
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Fax | 856-935-6772
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Provider Business Mailing Address
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Address Line | 227 LAUREL RD SUITE 300
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City | VOORHEES
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State | NJ
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Zip | 08043-8303
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Country | US
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Telephone | 856-770-3044
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Fax | 856-770-1515
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA02513800
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License Number State | NJ
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