Active NPI
Seon Jung Shelly Park
- Pharmacist
- New York, NY
National Provider Identifier
1659556819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 046554
- Practice address
- 67 Broad St
New York, NY 10004-2415 - Phone
- (212) 943-3690
- Fax
- (212) 425-1945
- NPI assigned
- Jan 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 046554 | NY | Primary |
Addresses
Primary practice location
67 Broad St
New York, NY 10004-2415
Mailing address
18930 37TH Ave
Unit B
Flushing, NY 11358-2302
Phone (646) 262-5161
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01993824 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046554 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duane Reade | Past | Accepting new patients | |
| Duane Reade | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443398400000",
"number": "1659556819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18930 37TH AVE",
"address_2": "UNIT B",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113582302",
"telephone_number": "646-262-5161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 BROAD ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100042415",
"telephone_number": "212-943-3690",
"fax_number": "212-425-1945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SEON JUNG SHELLY",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-07",
"last_updated": "2015-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "046554",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01993824",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.