Provider Demographics
NPI:1083931323
Name:TALBOT, EUNJA PARK (PSYD,)
Entity Type:Individual
Prefix:DR
First Name:EUNJA
Middle Name:PARK
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HARDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5349
Mailing Address - Country:US
Mailing Address - Phone:917-968-8209
Mailing Address - Fax:
Practice Address - Street 1:23 HARDWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5349
Practice Address - Country:US
Practice Address - Phone:917-968-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68019961103G00000X, 103T00000X
NJ5187103T00000X, 103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist