Provider Demographics
NPI:1003021817
Name:PAK, RENE Y
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:Y
Last Name:PAK
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 1:40 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5340
Mailing Address - Country:US
Mailing Address - Phone:973-984-2800
Mailing Address - Fax:973-984-7693
Practice Address - Street 1:40 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5340
Practice Address - Country:US
Practice Address - Phone:973-984-2800
Practice Address - Fax:973-984-7693
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00027200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist