Active NPI
Jinwoo Park
- Chiropractor
- Melville, NY
National Provider Identifier
1750798971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 012536
- Practice address
- 150 Broadhollow Rd Ste 316
Melville, NY 11747-4901 - Phone
- (917) 846-7921
- NPI assigned
- Jul 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 012536 | NY | Primary |
Addresses
Primary practice location
150 Broadhollow Rd Ste 316
Melville, NY 11747-4901
Mailing address
150 Broadhollow Rd Ste 316
Melville, NY 11747-4901
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 |
|---|---|---|---|
| 012536 | NY | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yy Wellcare Acupuncture P.C | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Acupuncturist
- Melville, NY
- NPI 1194341107
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593043200000",
"number": "1750798971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 BROADHOLLOW RD STE 316",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 BROADHOLLOW RD STE 316",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474901",
"telephone_number": "917-846-7921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JINWOO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-21",
"last_updated": "2020-06-25",
"certification_date": "2020-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "012536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.