Provider Demographics
NPI:1851618912
Name:STEVEN K. PARK, M. D., P.A.
Entity Type:Organization
Organization Name:STEVEN K. PARK, M. D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-935-7757
Mailing Address - Street 1:330 WOODSTOWN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2034
Mailing Address - Country:US
Mailing Address - Phone:856-935-7757
Mailing Address - Fax:856-935-5233
Practice Address - Street 1:330 WOODSTOWN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2034
Practice Address - Country:US
Practice Address - Phone:856-935-7757
Practice Address - Fax:856-935-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02513800305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service