Active NPI
Heakyoung Park, MD
- Pediatrics Physician
- Bronx, NY
National Provider Identifier
1043304355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 170830
- Practice address
- 817 E 180 St
Bronx, NY 10460 - Phone
- (718) 716-2089
- Fax
- (718) 294-9403
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 170830 | NY | Primary |
Addresses
Primary practice location
817 E 180 St
Bronx, NY 10460
Mailing address
817 E 180 St
Bronx, NY 10460
Phone (718) 716-2089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111201000107 | NY | Practitioner - Pediatric Medicine | 0042484081 | Practice locations: Bronx, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1043304355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "817 E 180 ST",
"city": "BRONX",
"state": "NY",
"postal_code": "10460",
"telephone_number": "718-716-2089",
"fax_number": "718-716-2089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "817 E 180 ST",
"city": "BRONX",
"state": "NY",
"postal_code": "10460",
"telephone_number": "718-716-2089",
"fax_number": "718-294-9403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "HEAKYOUNG",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "170830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.