Provider Demographics
NPI:1558818385
Name:PARK, INSUN (DC)
Entity Type:Individual
Prefix:DR
First Name:INSUN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINSTON DR APT 6BN
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3264
Mailing Address - Country:US
Mailing Address - Phone:201-575-2783
Mailing Address - Fax:
Practice Address - Street 1:2175 HUDSON TER
Practice Address - Street 2:9B
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7721
Practice Address - Country:US
Practice Address - Phone:201-575-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00523300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor