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NPI Code Detail

MEDICARE: DONGHWAN PARK

MEDICARE: DONGHWAN 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
1225100000XPhysical Therapist041262NY

General Provider Information

NPI Number : 1265916423
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONGHWAN PARK
Provider Business Mailing Address
First Line : 42 BROADWAY STE 1219
Second Line :
City : NEW YORK
State : NY
Zip : 10004-3834
Country : US
Telephone Number : 917-592-2207
Fax Number :
Provider Business Practice Location Address
First Line : 42 BROADWAY STE 1219
Second Line :
City : NEW YORK
State : NY
Zip : 10004-3834
Country : US
Telephone Number : 917-592-2207
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2018
Last Update Date : 08/18/2023

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Directions to “ DONGHWAN PARK ” Practice Location

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