Chan Soo Park, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

127160 Issued in NY

Practice address

205 South Ave
Suite 103
Poughkeepsie, NY 12601-4818

Phone

(845) 454-2360

Fax

(845) 454-2361

NPI assigned

Aug 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  Medicare reassignment
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Binghamton, NY
  • NPI 1316088941
  NPD

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1861485484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SOUTH AVE",
            "address_2": "SUITE 103",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126014818",
            "telephone_number": "845-454-2360",
            "fax_number": "845-454-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SOUTH AVE",
            "address_2": "SUITE 103",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126014818",
            "telephone_number": "845-454-2360",
            "fax_number": "845-454-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHAN SOO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "127160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00503613",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frances Patricia Pargament, LCSWR
• Karanjit Singh Parihar, M.D.
• Carol Paris-Steffens, LCSWR
• Kristin Ann Parise, LMSW
• Parisi Dermatology, PLLC
• Nicholas Ryan Park
• Roy H. Park, DDS
• Walter Roberts Parker, MD
• Allison Parks
• Loretta Parrish, LCSW-R, CASAC

• Neurology Physician in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Neurology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.