MEDICARE: MEDICAL PARK IMAGING, PA

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1417902446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PARK IMAGING, PA

Provider Business Mailing Address
First Line	:	10335 N PORT WASHINGTON RD
Second Line	:	SUITE 250
City	:	MEQUON
State	:	WI
Zip	:	53092-5763
Country	:	US
Telephone Number	:	262-240-9870
Fax Number	:	262-240-9869

Provider Business Practice Location Address
First Line	:	330 RATZER RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7702
Country	:	US
Telephone Number	:	973-696-5770
Fax Number	:	973-633-1204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOUNG LEE
Credential	:	MD
Telephone Number	:	973-696-5770

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	05/13/2008

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