Provider Demographics
NPI:1043644271
Name:PARK, INHYE
Entity Type:Individual
Prefix:
First Name:INHYE
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 1:30 W HARRIET AVE
Mailing Address - Street 2:AOT 2E
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1033
Mailing Address - Country:US
Mailing Address - Phone:716-708-7808
Mailing Address - Fax:
Practice Address - Street 1:30 W HARRIET AVE
Practice Address - Street 2:AOT 2E
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1033
Practice Address - Country:US
Practice Address - Phone:716-708-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse