Provider Demographics
NPI:1740694918
Name:PARK, MICHELLE E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:E
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 5TH AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8856
Mailing Address - Country:US
Mailing Address - Phone:212-256-1075
Mailing Address - Fax:866-493-9161
Practice Address - Street 1:2 5TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8856
Practice Address - Country:US
Practice Address - Phone:212-256-1075
Practice Address - Fax:866-493-9161
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292503-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology