Provider Demographics
NPI:1962477042
Name:PARK, STEVEN YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:YOUNG
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOSPITAL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1464
Mailing Address - Country:US
Mailing Address - Phone:814-375-6467
Mailing Address - Fax:814-375-6469
Practice Address - Street 1:145 HOSPITAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1464
Practice Address - Country:US
Practice Address - Phone:814-375-6467
Practice Address - Fax:814-375-6469
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD483193207Y00000X
NY203092207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04Z561Medicare ID - Type UnspecifiedMEDICARE
G66735Medicare UPIN