Provider Demographics
NPI:1215137971
Name:PARK, YOUNG SEOK (PT & L, AC)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:SEOK
Last Name:PARK
Suffix:
Gender:M
Credentials:PT & L, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548
Mailing Address - Country:US
Mailing Address - Phone:516-623-2277
Mailing Address - Fax:516-623-2525
Practice Address - Street 1:2016 GRAND AVE.
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-623-2277
Practice Address - Fax:516-623-2525
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017070225100000X
NY002591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08327GMedicare PIN