Provider Demographics
NPI:1780700781
Name:PARK, SOO-MI MI (MD)
Entity type:Individual
Prefix:
First Name:SOO-MI
Middle Name:MI
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 ESSEX AVENUE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1215
Mailing Address - Country:US
Mailing Address - Phone:201-996-9244
Mailing Address - Fax:201-996-9243
Practice Address - Street 1:493 ESSEX AVENUE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1215
Practice Address - Country:US
Practice Address - Phone:201-996-9244
Practice Address - Fax:201-996-9243
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237492207R00000X
NJ25MA08918200207UN0902X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease