Provider Demographics
NPI:1083960017
Name:PARK, HANNAH H
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:H
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 1:67 WALL ST
Mailing Address - Street 2:APT 9M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3187
Mailing Address - Country:US
Mailing Address - Phone:917-502-3076
Mailing Address - Fax:
Practice Address - Street 1:67 WALL ST
Practice Address - Street 2:APT 9M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-3101
Practice Address - Country:US
Practice Address - Phone:917-502-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423390101174400000X
NY423391101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist