Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 259224 | NY |
NPI | 1295170686 |
---|---|
Provider Name | Dr. Isabella Park |
First Address | Little Neck, NY 11362-2539 |
Second Address | Jamaica, NY 11418-2832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 30/04/2013 |