Provider Demographics
NPI:1104210632
Name:HONG SIK PAK MD COREA REHAB PAIN CLINIC
Entity Type:Organization
Organization Name:HONG SIK PAK MD COREA REHAB PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-446-6701
Mailing Address - Street 1:725 GRAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1045
Mailing Address - Country:US
Mailing Address - Phone:201-446-6701
Mailing Address - Fax:201-840-7008
Practice Address - Street 1:725 GRAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1045
Practice Address - Country:US
Practice Address - Phone:201-446-6701
Practice Address - Fax:201-840-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07185900225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty