| NPI | 1194023135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIA PARK Owner 718-229-4090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 174400000X Specialist | |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2021-03-19 |