Provider Demographics
NPI:1831498666
Name:UNITED MEDICAL PC
Entity Type:Organization
Organization Name:UNITED MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-460-0063
Mailing Address - Street 1:612 RUTHERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1217
Mailing Address - Country:US
Mailing Address - Phone:201-460-0063
Mailing Address - Fax:201-460-1684
Practice Address - Street 1:19 E 27TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4608
Practice Address - Country:US
Practice Address - Phone:201-339-6111
Practice Address - Fax:201-339-6333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ933910133V00000X
NJ27OA00343600152W00000X
NJ25MA08490600207QG0300X
NJ25MA04594000207R00000X
NJ25MA04562300207R00000X
NJ25MB05924000207R00000X
NJ25MA07920500207R00000X
NJ25MA06564500207RC0000X
NJ25MD00232400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0251623Medicaid
NJ0251623Medicaid