Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD457144 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | 208088 | NY |
NPI | 1154764017 |
---|---|
Provider Name | Dr. John Archibald Park |
First Address | Scarsdale, NY 10583-4724 |
Second Address | Valhalla, NY 10595-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 28/04/2020 |