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General NPI Number Information
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NPI Number | 1952926883
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Entity Type | Organization
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Legal Business Name | ELEVATE MEDICAL, LLC
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 210 5TH AVE, 2ND FL
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City | NEW YORK
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State | NY
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Zip | 10010
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Country | US
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Telephone | 212-812-4917
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Fax | 646-512-8058
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Provider Business Mailing Address
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Address Line | 210 5TH AVE, 2ND FL
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City | NEW YORK
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State | NY
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Zip | 10010
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Country | US
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Telephone | 212-812-4917
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Fax | 646-512-8058
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. YUNG PARK
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Credential | MD
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Telephone | 212-812-4917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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