Provider Demographics
NPI:1427077056
Name:PAK, HONG SIK (MD)
Entity type:Individual
Prefix:DR
First Name:HONG
Middle Name:SIK
Last Name:PAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LEMOINE AVE # 209
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6204
Mailing Address - Country:US
Mailing Address - Phone:201-840-5055
Mailing Address - Fax:
Practice Address - Street 1:2400 LEMOINE AVE # 209
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6204
Practice Address - Country:US
Practice Address - Phone:201-580-0725
Practice Address - Fax:201-363-8822
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA071859208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052408Medicare ID - Type Unspecified
NJH40164Medicare UPIN