Individual provider Active NPI

Minna Park

  • Speech-Language Pathologist
  • Bronx, NY
National Provider Identifier
1700383106
Registry record updated Apr 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
1225 Morris Park Avenue
The Van Etten Building
Bronx, NY 10461
Phone
(718) 430-8500
NPI assigned
Apr 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

1225 Morris Park Avenue
The Van Etten Building
Bronx, NY 10461

Mailing address

321 W 54TH St Apt 109
New York, NY 10019-5176

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180912000726 NY Practitioner - Qualified Speech Language Pathologist 7618227638 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Aug 10, 2018 Accepting new patients
Montefiore Medical Center CurrentSince Aug 10, 2018 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1225 Morris Park Ave
Bronx, NY 10461
Phone (718) 430-8500

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": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1700383106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 W 54TH ST APT 109",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100195176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 MORRIS PARK AVENUE",
            "address_2": "THE VAN ETTEN BUILDING",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10461",
            "telephone_number": "718-430-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MINNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.