MEDICARE: JUSEOK PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	024040	NY

General Provider Information

NPI Number	:	1265452312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSEOK PARK

Provider Business Mailing Address
First Line	:	839 58TH ST
Second Line	:	#3
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3679
Country	:	US
Telephone Number	:	917-750-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 58TH ST
Second Line	:	#3
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3679
Country	:	US
Telephone Number	:	917-750-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/12/2015

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Directions to “ JUSEOK PARK ” Practice Location

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