Provider Demographics
NPI:1730631466
Name:PARK, HYEYOUNG
Entity type:Individual
Prefix:
First Name:HYEYOUNG
Middle Name:
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 1:956 BANTA PL APT C
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1757
Mailing Address - Country:US
Mailing Address - Phone:917-623-0065
Mailing Address - Fax:
Practice Address - Street 1:118 BROAD AVE
Practice Address - Street 2:STE N10
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-2717
Practice Address - Country:US
Practice Address - Phone:201-313-1122
Practice Address - Fax:201-941-1157
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00580000363LF0000X
NYF339276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily