Provider Demographics
NPI:1235226960
Name:PARK, HYEUN S (MD)
Entity Type:Individual
Prefix:
First Name:HYEUN
Middle Name:S
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046
Mailing Address - Country:US
Mailing Address - Phone:973-334-7700
Mailing Address - Fax:973-334-7116
Practice Address - Street 1:415 BOULEVARD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046
Practice Address - Country:US
Practice Address - Phone:973-334-7700
Practice Address - Fax:973-334-7116
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08032900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08032900OtherMEDICAL LICENCE