NPIMap

Organization Active NPI

Park Medical Group PA

  • Specialist
  • Harrington Park, NJ
National Provider Identifier
1386685162
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA05743400 Issued in NJ
Legal business name
PARK MEDICAL GROUP PA
Practice address
24 Elm St
Harrington Park, NJ 07640-1902
Phone
(201) 784-0123
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Authorized official

Name
Dr. Stephen Brunnquell, MDNPI 1740281310
Title
Delegated Official
Phone
(201) 784-0123

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 25MA05743400 NJ Primary

Addresses

Primary practice location

24 Elm St
Harrington Park, NJ 07640-1902

Mailing address

24 Elm St
Harrington Park, NJ 07640-1902
Phone (201) 784-0123

Other identifiers 6

IdentifierTypeStateIssuer
0048302001OtherNJKEYSTONE GROUP #
0048302002OtherNJAMERIHEALTH GROUP # T
0048302004OtherNJAMERIHEALTH GROUP # NV
CB3927OtherNJRRMDCR GROUP #
0048302001OtherNJAMERIHEALTH GROUP # HP
7298803MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1386685162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 ELM ST",
            "city": "HARRINGTON PARK",
            "state": "NJ",
            "postal_code": "076401902",
            "telephone_number": "201-784-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 ELM ST",
            "city": "HARRINGTON PARK",
            "state": "NJ",
            "postal_code": "076401902",
            "telephone_number": "201-784-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "BRUNNQUELL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "201-784-0123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA05743400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE GROUP #",
            "identifier": "0048302001",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP # T",
            "identifier": "0048302002",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP # NV",
            "identifier": "0048302004",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMDCR GROUP #",
            "identifier": "CB3927",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP # HP",
            "identifier": "0048302001",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7298803",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrington Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.