Michelle E Park, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

292503-1 Issued in NY

Practice address

2 5TH Ave Unit 2
New York, NY 10011-8856

Phone

(212) 256-1075

Fax

(866) 493-9161

NPI assigned

Jun 16, 2014

Sex

Female

Sole proprietor

No

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 NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Albert Einstein College of Medicine of Yeshiva University, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Washington Square Dermatology, LLCGroup PAC ID 6305163023, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Washington Square Dermatology LLC

  • Dermatology Physician
  • New York, NY
  • NPI 1811385933
  Medicare reassignment Care Compare group NPD
• Washington Square Dermatology

  • Dermatology Physician
  • New York, NY
  • NPI 1205376530
  NPD (past)

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538956800000",
    "number": "1740694918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 5TH AVE UNIT 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118856",
            "telephone_number": "212-256-1075",
            "fax_number": "866-493-9161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 5TH AVE UNIT 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118856",
            "telephone_number": "212-256-1075",
            "fax_number": "866-493-9161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-2680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "MICHELLE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-16",
        "last_updated": "2018-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "292503-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Park, M.D.
• Madeleine Park, PA-C
• Maria Fe Park, NP
• Mark Park, DDS
• Michael Park, MD
• Mijung Park
• Minha Park, PT, DPT
• Minjung NMN Park, BCBA/LBA
• NA Hyun Park, MD
• Nam Park

• Dermatology Physician in New York, NY
• Providers in New York, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; 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.