Myoung Ae Park, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ00428200 Issued in NJ

Practice address

988 Broadway
Bayonne, NJ 07002-4036

Phone

(201) 339-6111

Fax

(201) 339-6333

NPI assigned

Apr 10, 2013

Last updated

May 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

BHMG - United MedicalGroup PAC ID 5193949865, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpark123909@epicdirect.rwjbh.org

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

• BHMG - United Medical

  • Internal Medicine Physician
  • Lyndhurst, NJ
  • NPI 1639594377
  Medicare reassignment Care Compare group NPD
• Rapid Access Medical Diagnostics NJ LLC

  • Diagnostic Ultrasound Physician
  • Randolph, NJ
  • NPI 1780940551
  NPD (past)

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714694400000",
    "number": "1396188215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "988 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070024036",
            "telephone_number": "201-339-6111",
            "fax_number": "201-339-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "988 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070024036",
            "telephone_number": "201-339-6111",
            "fax_number": "201-339-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MYOUNG",
        "middle_name": "AE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-10",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00428200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thanmayi Panguluri, DDS
• Joseph Gerard Paolini, RPH
• Neloufar Papasmiris, PHARMD
• John W Park, PHARMD
• Minah Park
• Angela Marie Parlo, PHARMD
• Joel Nicholas Pascuzzi, DMD
• Parul Patel-Gupta
• Kinnary Patel, OTR/L
• Minjal Patel, DO

• Gerontology Nurse Practitioner in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.