Individual
JAMIE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 GRAND AVE STE 203, ENGLEWOOD, NJ 07631-4363
(201) 588-0444
Mailing address
24 CAMPBELL AVE, AIRMONT, NY 10901-6302
(845) 538-3767
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
02200576964
NY
363LF0000X
Family Nurse Practitioner
Primary
26NR00439400
NJ
363LF0000X
Family Nurse Practitioner
F337600-1
NY
Other
Enumeration date
06/04/2010
Last updated
12/21/2016
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