Paul Park, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

020500 Issued in NY

Practice address

1115 Broadway FL 12
New York, NY 10010-3452

Phone

(646) 504-3596

NPI assigned

Apr 9, 2014

Last updated

Jan 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park Psychology PLLC

  • Adult Mental Health Clinic/Center
  • New York, NY
  • NPI 1144800194

  Psychologist

  NPD Authorized official

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1821417668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 BROADWAY FL 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100103452",
            "telephone_number": "646-504-3596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 BROADWAY FL 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100103452",
            "telephone_number": "646-504-3596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 Frelinghuysen Rd",
            "address_purpose": "LOCATION",
            "city": "Piscataway",
            "state": "NJ",
            "postal_code": "088548020",
            "country_code": "US",
            "telephone_number": "848-445-6002",
            "fax_number": "732-445-0127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-09",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "020500",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "5326",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "020500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minjung NMN Park, BCBA/LBA
• NA Hyun Park, MD
• Nam Park
• Nayoung Park, FNP
• Paul Park, MD
• Robert Y. Park, M.D.
• Royce Park, MD
• Sandra W Park, MD
• Sanghee Sophie Park
• Sangmi Julie Park, MD

• Clinical Psychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; 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.