=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982578472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK YOUR HEADACHE NEUROLOGY PHYSICIAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 E EVESHAM RD STE 211
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-783-7392
-----------------------------------------------------
Fax | 856-455-3373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 E EVESHAM RD STE 211
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-783-7392
-----------------------------------------------------
Fax | 856-455-3373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/MANAGER
-----------------------------------------------------
Name | HANNAH PARK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 856-783-7392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------