Provider Demographics
NPI:1033851837
Name:PAL PARK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PAL PARK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HYEO YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:201-313-1122
Mailing Address - Street 1:118 BROAD AVE # 9
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2717
Mailing Address - Country:US
Mailing Address - Phone:201-313-1122
Mailing Address - Fax:201-941-1157
Practice Address - Street 1:118 BROAD AVE # 9
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00899500OtherLINCENSE