Provider Demographics
NPI:1013216845
Name:UNITED MEDICAL PC
Entity Type:Organization
Organization Name:UNITED MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-460-0063
Mailing Address - Street 1:612 RUTHERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1217
Mailing Address - Country:US
Mailing Address - Phone:201-460-0063
Mailing Address - Fax:201-460-1684
Practice Address - Street 1:300 PARKER AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1456
Practice Address - Country:US
Practice Address - Phone:973-548-6844
Practice Address - Fax:973-546-7707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ933910133V00000X
NJ25MA03527700207Q00000X
NJ25MA08490600207QG0300X
NJ25MA08015300207R00000X
NJ25MA07920500207R00000X
NJ25MA08431800207R00000X
NJ25MA05539300207RC0000X
NJ25MD00232400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0251623Medicaid
NJ501164Medicare PIN