Provider Demographics
NPI:1609138791
Name:PARK, OLGA (MD)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WILLIAMSON ST STE 320
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2909
Mailing Address - Country:US
Mailing Address - Phone:908-994-5750
Mailing Address - Fax:908-558-0269
Practice Address - Street 1:200 WILLIAMSON ST STE 320
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-2909
Practice Address - Country:US
Practice Address - Phone:908-994-5750
Practice Address - Fax:908-558-0269
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10429000208000000X
TXQ2820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics