Chang S Park, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

173037-1 Issued in NY

Practice address

200 Old Palisade Rd Apt 1E
Fort Lee, NJ 07024-7057

Phone

(201) 592-0619

NPI assigned

Jun 20, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371686400000",
    "number": "1740629948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OLD PALISADE RD APT 1E",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070247057",
            "telephone_number": "201-592-0619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OLD PALISADE RD APT 1E",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070247057",
            "telephone_number": "201-592-0619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHANG",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-20",
        "last_updated": "2013-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "173037-1",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA05299100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palisades Oral Surgery
• Palisades Park Podiatry PC
• Palisades Surgical Suites, LLC
• Palisdes Periodontics
• Elizabeth Palughi
• Clara Park, DDS
• David Park, DPT
• David Spring Park, LAC
• Eugene Park, L.AC, PA-C
• Haeri Park

• Internal Medicine Physician in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; 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.