Provider Demographics
NPI:1528229200
Name:PARK, JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2331
Mailing Address - Country:US
Mailing Address - Phone:201-429-3996
Mailing Address - Fax:
Practice Address - Street 1:962 KINDERKAMACK ROAD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2331
Practice Address - Country:US
Practice Address - Phone:201-429-3996
Practice Address - Fax:201-812-9604
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031471225100000X
NJ40QA01252200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist