Provider Demographics
NPI:1326086158
Name:PARK, SANDRA W (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:W
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:113 1/2 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7301
Mailing Address - Country:US
Mailing Address - Phone:212-308-1980
Mailing Address - Fax:212-308-1980
Practice Address - Street 1:113 1/2 E 62ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7301
Practice Address - Country:US
Practice Address - Phone:212-308-1980
Practice Address - Fax:212-308-1980
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2190332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIOO379Medicare UPIN