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NPI Code Detail

MEDICARE: MS. SEOUN H PARK ANP

MEDICARE: MS. SEOUN H PARK ANP
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
1163W00000XRegistered Nurse680166NY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner26NJ15069000NJ

General Provider Information

NPI Number : 1396168480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SEOUN H PARK ANP
Provider Business Mailing Address
First Line : 16A MARA RD
Second Line :
City : LAKE HIAWATHA
State : NJ
Zip : 07034-1350
Country : US
Telephone Number : 201-602-2726
Fax Number :
Provider Business Practice Location Address
First Line : 992 CLIFTON AVE
Second Line :
City : CLIFTON
State : NJ
Zip : 07013-3502
Country : US
Telephone Number : 862-249-1266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2014
Last Update Date : 10/08/2024

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Directions to “ MS. SEOUN H PARK ANP” Practice Location

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