Provider Demographics
NPI:1265512768
Name:HYUNG C PARK PHYSICIAN PC
Entity type:Organization
Organization Name:HYUNG C PARK PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORCIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-855-2866
Mailing Address - Street 1:2882 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1325
Mailing Address - Country:US
Mailing Address - Phone:716-855-2866
Mailing Address - Fax:
Practice Address - Street 1:2882 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1325
Practice Address - Country:US
Practice Address - Phone:716-855-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX79161Medicare UPIN
NYAA1349Medicare PIN