Individual
HEYSOOK PARK WANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1315 YORK AVE, NEW YORK, NY 10021-5304
(212) 746-5077
Mailing address
568 ASHFORD AVE, ARDSLEY, NY 10502-1602
(917) 843-5667
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
F339118
NY
Other
Enumeration date
11/15/2016
Last updated
10/14/2021
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