Individual
DEIDRA G PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
125 ESSEX ST, HACKENSACK, NJ 07601-4027
(201) 646-2756
Mailing address
105 WHITE POND RD, WALDWICK, NJ 07463-1349
(201) 447-0548
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235317298
NPI#
NJ
Enumeration date
06/06/2011
Last updated
06/06/2011
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