Provider Demographics
NPI:1417252552
Name:PARK & PARK HEALTHY CHOICE LLC
Entity Type:Organization
Organization Name:PARK & PARK HEALTHY CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T.
Authorized Official - Prefix:
Authorized Official - First Name:KWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-359-3777
Mailing Address - Street 1:142-25 37TH AVE., #C3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:142-25 37TH AVE., #C3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6530
Practice Address - Country:US
Practice Address - Phone:718-359-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty