MEDICARE: DONG HYOUK 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	039217	NY

General Provider Information

NPI Number	:	1811686629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONG HYOUK PARK

Provider Business Mailing Address
First Line	:	87 MANORHAVEN BLVD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1521
Country	:	US
Telephone Number	:	347-242-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	6424 11TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5639
Country	:	US
Telephone Number	:	718-333-5360
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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Directions to “ DONG HYOUK PARK ” Practice Location

Language	Start Address	Practice Location

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