Chang S S Park, M.D

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA07699600 Issued in NJ

Practice address

118 Broad Ave N9
Palisades Park, NJ 07650

Phone

(201) 482-0439

Fax

(201) 482-8703

NPI assigned

Jul 21, 2006

Reactivated

May 10, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Advanced Anesthesia Associates,Inc

  • Anesthesiology Physician
  • Youngstown, OH
  • NPI 1538117460
  NPD (past)
• Pain Center of Western Pennsylvania, Inc

  • Pain Medicine (Anesthesiology) Physician
  • Hermitage, PA
  • NPI 1801804612
  NPD (past)
• Pain Management Clinic

  • Specialist
  • New Castle, PA
  • NPI 1114229895
  NPD (past)
• Tower Anesthesia and Pain Solutions, Inc

  • Pain Medicine (Anesthesiology) Physician
  • Sharon, PA
  • NPI 1326119058
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470096000000",
    "number": "1275554610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 BROAD AVE N9",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "07650",
            "telephone_number": "201-482-0439",
            "fax_number": "201-482-8703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 BROAD AVE N9",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "07650",
            "telephone_number": "201-482-0439",
            "fax_number": "201-482-8703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHANG S",
        "middle_name": "S",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2016-08-02",
        "deactivation_date": "2016-04-18",
        "reactivation_date": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA07699600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palisades Park Dental P.C.
• Palisades Park Medicine, P.C.
• Palisades Park School District
• Palpark Physical Therapy
• Maria Elena Parisi
• Hyewon Park, DNP
• Inhye Park
• Jennifer Mijin Park
• Ji Hae Park, M.D.
• Ji Young Park, L.AC

• Specialist in Palisades Park, NJ
• Providers in Palisades Park, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2016; 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.