Provider Demographics
NPI:1093396137
Name:EUNICE PARK MD PLLC
Entity Type:Organization
Organization Name:EUNICE PARK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-614-1880
Mailing Address - Street 1:428 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4509
Mailing Address - Country:US
Mailing Address - Phone:516-614-1880
Mailing Address - Fax:516-654-8585
Practice Address - Street 1:428 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4509
Practice Address - Country:US
Practice Address - Phone:516-614-1880
Practice Address - Fax:516-654-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty