Active NPI
Min Joo Park
- Pharmacist
- Bayside, NY
National Provider Identifier
1760859060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 060853
- Practice address
- 3920 Bell Blvd
Bayside, NY 11361-2061 - Phone
- (718) 224-2606
- Fax
- (718) 224-8083
- NPI assigned
- Aug 21, 2015
- Last updated
- Aug 21, 2015
- 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 | 060853 | NY | Primary |
Addresses
Primary practice location
3920 Bell Blvd
Bayside, NY 11361-2061
Mailing address
3920 Bell Blvd
Bayside, NY 11361-2061
Phone (718) 224-2606
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060853 | Other | NY | PHARMACIST LICENSE |
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 |
|---|---|---|---|
| 060853 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlantic Consultants LLC | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440115200000",
"number": "1760859060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 BELL BLVD",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113612061",
"telephone_number": "718-224-2606",
"fax_number": "718-224-8083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 BELL BLVD",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113612061",
"telephone_number": "718-224-2606",
"fax_number": "718-224-8083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MIN JOO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-21",
"last_updated": "2015-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "060853",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "060853",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bayside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.