Provider Demographics
NPI:1487921540
Name:PARK, BRANDON HYUNGKI (PT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:HYUNGKI
Last Name:PARK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1066
Mailing Address - Country:US
Mailing Address - Phone:201-602-9726
Mailing Address - Fax:
Practice Address - Street 1:71 S COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1066
Practice Address - Country:US
Practice Address - Phone:201-602-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01425200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist