Provider Demographics
NPI:1780684167
Name:PARK, ERICA NICOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:NICOLA
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:95 MOUNT KEMBLE AVE
Mailing Address - Street 2:THEBAUD BLDG. 4TH FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5155
Mailing Address - Country:US
Mailing Address - Phone:973-796-3600
Mailing Address - Fax:973-267-3144
Practice Address - Street 1:95 MOUNT KEMBLE AVE
Practice Address - Street 2:THEBAUD BLDG. 4TH FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5155
Practice Address - Country:US
Practice Address - Phone:973-796-3600
Practice Address - Fax:973-267-3144
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07753800208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072770Medicaid
NJ086285Medicare PIN
I22375Medicare UPIN