Windsor Park Family Medicine, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

043254 Issued in CT

Legal business name

WINDSOR PARK FAMILY MEDICINE, LLC

Practice address

85 Felt Road
Suite 501
South Windsor, CT 06074

Phone

(860) 228-2750

Fax

(860) 783-5460

NPI assigned

Aug 20, 2009

Last updated

Aug 20, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hyoungsup Park, MD

Title

Owner

Phone

(860) 288-2750

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1922230200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 FELT ROAD",
            "address_2": "SUITE 501",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "06074",
            "telephone_number": "860-228-2750",
            "fax_number": "860-783-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 FELT ROAD",
            "address_2": "SUITE 501",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "06074",
            "telephone_number": "860-228-2750",
            "fax_number": "860-783-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDSOR PARK FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "HYOUNGSUP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-288-2750",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "043254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; 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.