Provider Demographics
NPI:1740376987
Name:PARK, MARGARET CHU (DMD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:CHU
Last Name:PARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 CENTER AVE
Mailing Address - Street 2:#1-C
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5806
Mailing Address - Country:US
Mailing Address - Phone:201-944-6944
Mailing Address - Fax:201-944-7752
Practice Address - Street 1:2150 CENTER AVE
Practice Address - Street 2:#1-C
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5806
Practice Address - Country:US
Practice Address - Phone:201-944-6944
Practice Address - Fax:201-944-7752
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI207861223X0400X
NY0484821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223701182OtherTIN