Provider Demographics
NPI:1306048087
Name:PARK, JEAN YOUNG (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:YOUNG
Last Name:PARK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:STE. 300
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:STE. 300
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4326
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2013-10-08
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Provider Licenses
StateLicense IDTaxonomies
NY234055207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400001625Medicare PIN