Provider Demographics
NPI:1245467711
Name:STEVE B. PARK M.D. PC
Entity type:Organization
Organization Name:STEVE B. PARK M.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-328-0153
Mailing Address - Street 1:2300 BUFFALO ROAD
Mailing Address - Street 2:BLDG 700
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1367
Mailing Address - Country:US
Mailing Address - Phone:585-328-0153
Mailing Address - Fax:585-328-0158
Practice Address - Street 1:160 SAWGRASS DR
Practice Address - Street 2:STE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4648
Practice Address - Country:US
Practice Address - Phone:585-244-2200
Practice Address - Fax:585-244-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364010Medicaid
NY11217AOtherMEDICARE ID-TYPE UNSPECIFIED
NY00468162Medicaid
NY01445376Medicaid
NY01728156Medicaid
NY00466308Medicaid
NY01093163Medicaid
NYB77460Medicare UPIN
NYG12766Medicare UPIN
NYU50695Medicare UPIN
NY01728156Medicaid
NYB72013Medicare UPIN
NY00466308Medicaid
NYU25116Medicare UPIN
NY02364010Medicaid
NY11217AOtherMEDICARE ID-TYPE UNSPECIFIED
NYT26179Medicare UPIN
NY00468162Medicaid
NY0916200002Medicare NSC