Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305432 | NY |
NPI | 1023324068 |
---|---|
Provider Name | Changhee Paek |
First Address | Jersey City, NJ 07310-2088 |
Second Address | East Orange, NJ 07018-1023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2010 |
Last Update Date | 04/11/2015 |