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General NPI Number Information
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NPI Number | 1851618912
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Entity Type | Organization
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Legal Business Name | STEVEN K. PARK, M. D., P.A.
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 330 WOODSTOWN RD SUITE 3
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City | SALEM
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State | NJ
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Zip | 08079-2034
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Country | US
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Telephone | 856-935-7757
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Fax | 856-935-5233
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Provider Business Mailing Address
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Address Line | 330 WOODSTOWN RD SUITE 3
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City | SALEM
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State | NJ
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Zip | 08079-2034
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Country | US
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Telephone | 856-935-7757
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Fax | 856-935-5233
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN K PARK
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Credential | M.D
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Telephone | 856-935-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 25MA02513800
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License Number State | NJ
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