Provider Demographics
NPI:1851482228
Name:PAK, SOO MEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SOO MEE
Middle Name:
Last Name:PAK
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 1:112 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5042
Mailing Address - Country:US
Mailing Address - Phone:845-634-2900
Mailing Address - Fax:845-634-3066
Practice Address - Street 1:112 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5042
Practice Address - Country:US
Practice Address - Phone:845-634-2900
Practice Address - Fax:845-634-3066
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193902207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG82119Medicare UPIN