Joseph Sungjae Park, | |
17 Brinkerhoff Ter # 202, Palisades Park, NJ 07650-1101 | |
(201) 313-1212 | |
Not Available |
Full Name | Joseph Sungjae Park |
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Gender | Male |
Speciality | Chiropractor |
Location | 17 Brinkerhoff Ter # 202, Palisades Park, New Jersey |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1144919721 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | X013693-01 (New York) | Secondary |
111N00000X | Chiropractor | 38MC00795900 (New Jersey) | Primary |
Provider Name | Jsp Chiropractic Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1518657352 PECOS PAC ID: 5698138485 Enrollment ID: O20230828000036 |
Mailing Address | Practice Location Address |
---|---|
Joseph Sungjae Park, 555 Gorge Rd Apt 5f, Cliffside Park, NJ 07010-2240 Ph: (201) 388-5332 | Joseph Sungjae Park, 17 Brinkerhoff Ter # 202, Palisades Park, NJ 07650-1101 Ph: (201) 313-1212 |
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