NPIMap

Organization Active NPI

United Medical PC

  • Internal Medicine Physician
  • Bayonne, NJ
National Provider Identifier
1831498666
Registry record updated Mar 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA04594000 Issued in NJ
Legal business name
UNITED MEDICAL PC
Practice address
19 E 27TH St
Bayonne, NJ 07002-4608
Phone
(201) 339-6111
Fax
(201) 339-6333
NPI assigned
Mar 18, 2011
Organization subpart
Yes
Parent organization
UNITED MEDICAL PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2011

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

Authorized official

Name
Dr. Byong Park, M.D.
Title
President & Medical Director
Phone
(201) 460-0063

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X 933910 NJ
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 27OA00343600 NJ
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X 25MA08490600 NJ
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA04594000 NJ Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA04562300 NJ
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MB05924000 NJ
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA07920500 NJ
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X 25MA06564500 NJ
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 25MD00232400 NJ

Addresses

Primary practice location

19 E 27TH St
Bayonne, NJ 07002-4608

Mailing address

612 Rutherford Ave
Lyndhurst, NJ 07071-1217
Phone (201) 460-0063

Other identifiers 1

IdentifierTypeStateIssuer
0251623MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
United Medical PC6 organizations share this tax ID, including this one
Part of
United Medical PC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1831498666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 RUTHERFORD AVE",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070711217",
            "telephone_number": "201-460-0063",
            "fax_number": "201-460-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E 27TH ST",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070024608",
            "telephone_number": "201-339-6111",
            "fax_number": "201-339-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED MEDICAL PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNITED MEDICAL PC",
        "enumeration_date": "2011-03-18",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "BYONG",
        "authorized_official_title_or_position": "PRESIDENT & MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "201-460-0063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": "933910",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00343600",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA08490600",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA04594000",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA04562300",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB05924000",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07920500",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA06564500",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00232400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251623",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayonne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; 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.