Provider Demographics
NPI:1215459862
Name:PARK, JULIE J
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:J
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 KINGSLEY STREET
Mailing Address - Street 2:APT 2F
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605
Mailing Address - Country:US
Mailing Address - Phone:201-344-3769
Mailing Address - Fax:
Practice Address - Street 1:113 KINGSLEY STREET
Practice Address - Street 2:APT 2F
Practice Address - City:LEONI
Practice Address - State:NJ
Practice Address - Zip Code:07605
Practice Address - Country:US
Practice Address - Phone:201-344-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist