Provider Demographics
NPI:1295231074
Name:PARK, GREER MORGAN (DO)
Entity Type:Individual
Prefix:
First Name:GREER
Middle Name:MORGAN
Last Name:PARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 AMSTERDAM AVE STE 16-A2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-523-5194
Mailing Address - Fax:212-523-3642
Practice Address - Street 1:1090 AMSTERDAM AVE STE 16-A2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-5194
Practice Address - Fax:212-523-3642
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0728052084P0800X
IL036.1557792084P0800X
NY3143852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry