Individual provider Active NPI

Junno Park, DPM

  • Podiatrist
  • Saddle River, NJ
National Provider Identifier
1417301219
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
006989 Issued in NY
Practice address
1 Melody LN Uppr
Saddle River, NJ 07458-1857
Phone
(732) 429-0177
NPI assigned
Apr 18, 2016
Last updated
Jun 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Podiatrist 213E00000X 006989 NY Primary

Addresses

Primary practice location

1 Melody LN Uppr
Saddle River, NJ 07458-1857

Mailing address

1 Melody LN Uppr
Saddle River, NJ 07458-1857
Phone (732) 429-0177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200831002800 NJ Practitioner - Podiatry 5991042236 Reassigns benefits to 2 organizations
I20251001000215 NY Practitioner - Podiatry 5991042236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Home Foot Care Services LLCGroup PAC ID 1850587528, 15 clinicians

Practice addresses (Care Compare)

146 Hillcrest Rd
Watchung, NJ 07069-6053
Phone (877) 417-3668

74 Three Ponds LN E
Woodbury, NY 11797-1816
Phone (732) 429-0177

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue31
Removal of nail tissue4095
Removal or shaving of skin growth2043

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006989NYMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Podiatry on Wheels PC Podiatrist CurrentSince Sep 1, 2025 Accepting new patients
Home Foot Care Services LLC CurrentSince Oct 1, 2020 Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1417301219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MELODY LN UPPR",
            "city": "SADDLE RIVER",
            "state": "NJ",
            "postal_code": "074581857",
            "telephone_number": "732-429-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MELODY LN UPPR",
            "city": "SADDLE RIVER",
            "state": "NJ",
            "postal_code": "074581857",
            "telephone_number": "732-429-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JUNNO",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "006989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saddle River, NJ

Sources for this page

Verify at the official NPI Registry.