Provider Demographics
NPI:1124066048
Name:UNITED MEDICAL PC
Entity type:Organization
Organization Name:UNITED MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:612 RUTHERFORD AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1217
Practice Address - Country:US
Practice Address - Phone:201-460-0063
Practice Address - Fax:201-460-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ933910133V00000X
NJ25MA0352770207Q00000X
NJ25MA08490600207QG0300X
NJ25MA09171800207RC0000X
NJ25MA08599900207RE0101X
NJMA062232207RG0100X
NJ25MA0497600207RN0300X
NJ25MA05208400207V00000X
NJ25MA063700000207W00000X
NJ25MA08540700208100000X
NJMA0489662085R0204X
NJ26NJ00326000363LA2200X
NJ25MA04562300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07920500OtherMD LICENSE
NJ7930101Medicaid
NJ1163604Medicaid
NJ0174653Medicaid
978514OtherCERTIFICATE AMERICAN DIETETIC ASSOCIATION
NJ26NJ00326000OtherADVANCED NURSE PRACTITIONER
NJ7326505Medicaid
NJ25MD00232400OtherDPM LICENSE
NJ7027508Medicaid
NJ0251623Medicaid
NJ778225Medicare PIN
NJ276193Medicare PIN
11738363Medicare PIN
G86191Medicare UPIN
E39073Medicare UPIN
D06768Medicare UPIN
NJI23235Medicare UPIN
B80065Medicare UPIN
NJ010746Medicare PIN
C55066Medicare UPIN
879618Medicare PIN
NJ023282Medicare PIN
445649Medicare PIN
NJ162250Medicare PIN
131243Medicare PIN
NJ085392Medicare PIN
NJ1163604Medicaid
NJ0251623Medicaid
NJ183616Medicare PIN
157336Medicare PIN
135650Medicare PIN
578421Medicare PIN
978514OtherCERTIFICATE AMERICAN DIETETIC ASSOCIATION
NJ26NJ00326000OtherADVANCED NURSE PRACTITIONER
NJ25MD00232400OtherDPM LICENSE
G13264Medicare UPIN
G06605Medicare UPIN
T91758Medicare UPIN
A60310Medicare UPIN
533762Medicare PIN
905724Medicare PIN
NJ521361Medicare PIN
NJ519950Medicare PIN
450539Medicare PIN
129699Medicare PIN