NPIMap

Organization Active NPI

United Medical PC

  • Internal Medicine Physician
  • Lyndhurst, NJ
National Provider Identifier
1124066048
Registry record updated Feb 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA04562300 Issued in NJ
Legal business name
UNITED MEDICAL PC
Practice address
612 Rutherford Ave
Lyndhurst, NJ 07071-1217
Phone
(201) 460-0063
Fax
(201) 460-1684
NPI assigned
Jun 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2014

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

Authorized official

Name
Byong Park, M.D.
Title
President
Phone
(201) 460-0063

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X 933910 NJ
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 25MA0352770 NJ
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X 25MA08490600 NJ
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA04562300 NJ Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X 25MA09171800 NJ
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X 25MA08599900 NJ
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X MA062232 NJ
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 25MA0497600 NJ
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 25MA05208400 NJ
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 25MA063700000 NJ
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 25MA08540700 NJ
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X MA048966 NJ
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X 26NJ00326000 NJ

Addresses

Primary practice location

612 Rutherford Ave
Lyndhurst, NJ 07071-1217

Mailing address

612 Rutherford Ave
Lyndhurst, NJ 07071-1217
Phone (201) 460-0063

Other identifiers 10

IdentifierTypeStateIssuer
25MA07920500OtherNJMD LICENSE
7930101MedicaidNJ
1163604MedicaidNJ
0174653MedicaidNJ
978514OtherCERTIFICATE AMERICAN DIETETIC ASSOCIATION
26NJ00326000OtherNJADVANCED NURSE PRACTITIONER
7326505MedicaidNJ
25MD00232400OtherNJDPM LICENSE
7027508MedicaidNJ
0251623MedicaidNJ

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392076800000",
    "number": "1124066048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 RUTHERFORD AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711217",
            "telephone_number": "201-460-0063",
            "fax_number": "201-460-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 RUTHERFORD AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711217",
            "telephone_number": "201-460-0063",
            "fax_number": "201-460-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2014-02-11",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "BYONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-460-0063",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": "933910",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA0352770",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA08490600",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA04562300",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA09171800",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NJ",
            "license": "25MA08599900",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "MA062232",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA0497600",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA05208400",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA063700000",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "25MA08540700",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NJ",
            "license": "MA048966",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ00326000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "25MA07920500",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7930101",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1163604",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0174653",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE AMERICAN DIETETIC ASSOCIATION",
            "identifier": "978514",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANCED NURSE PRACTITIONER",
            "identifier": "26NJ00326000",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7326505",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPM LICENSE",
            "identifier": "25MD00232400",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7027508",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251623",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyndhurst, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.