Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X012187-1 | NY |
N | 111NN1001X | Nutrition | X012187-1 | NY |
N | 111NS0005X | Chiropractic Sports Physician | X012187 | NY |
NPI | 1063774693 |
---|---|
Provider Name | Dr. Andrew J Park |
First Address | New York, NY 10019-5230 |
Second Address | New York, NY 10019-5230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2012 |
Last Update Date | 31/01/2013 |