Tae Keun Park, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

25MA08835000 Issued in NJ

Practice address

300 Community Dr
Department of Emergency Medicine
Manhasset, NY 11030-3816

Phone

(516) 562-2925

NPI assigned

May 18, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Physician Services of New Jersey,Professional Association

  • Emergency Medicine Physician
  • Mount Holly, NJ
  • NPI 1831539568
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1093940249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 TEANECK RD DEPT OF",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664245",
            "telephone_number": "201-833-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COMMUNITY DR",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303816",
            "telephone_number": "516-562-2925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "718 Teaneck Rd",
            "address_purpose": "LOCATION",
            "city": "Teaneck",
            "state": "NJ",
            "postal_code": "076664245",
            "country_code": "US",
            "telephone_number": "201-833-3913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "TAE",
        "middle_name": "KEUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "NY",
            "license": "252574",
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "CA",
            "license": "A104548",
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "NJ",
            "license": "25MA08835000",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA08835000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Sungsik Park, MD
• Jung Park
• Paul Park
• Sandy Park, PHARMACIST
• Suna Chang Park, NP
• Kathleen Marie Parnell Magdich, NP
• Steven Parra, MD, MPH
• Aksha Parray, MD
• Michiko Anne Paschall, MD
• Patricia Paskewitz, NP

• Emergency Medicine Physician in Manhasset, NY
• Providers in Manhasset, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.