Active NPI
Jade Park, MD
- Neurology Physician
- New York, NY
National Provider Identifier
1992384598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 337317
- Practice address
- 10 Union SQ E Ste 5H
New York, NY 10003-3314 - Phone
- (212) 844-6897
- NPI assigned
- Apr 2, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 125077867 | IL | |
| Neurology Physician | 2084N0400X | 337317 | NY | Primary |
Addresses
Primary practice location
10 Union SQ E Ste 5H
New York, NY 10003-3314
Mailing address
108 Belmont Cir
Syosset, NY 11791-5733
Other practice location 1
1620 W Harrison St
Chicago, IL 60612-3801
Phone (312) 942-8525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210728001762 | IL | Order and Referring Only - Neurology | 2466855424 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 337317 | NY | MD | Licensed Practical Nurse |
| 125077867 | IL | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750204800000",
"number": "1992384598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 BELMONT CIR",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117915733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 UNION SQ E STE 5H",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100033314",
"telephone_number": "212-844-6897"
}
],
"practiceLocations": [
{
"address_1": "1620 W Harrison St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606123801",
"country_code": "US",
"telephone_number": "312-942-8525",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PARK",
"first_name": "JADE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-02",
"last_updated": "2025-06-18",
"certification_date": "2025-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IL",
"license": "125077867",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "337317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.