Individual
DR. JISOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
109 W 27TH ST STE 5S, NEW YORK, NY 10001-6208
(833) 351-8255
Mailing address
PUTNAM HALL, STONY BROOK, NY 11794-0001
(631) 632-9510
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0102207594
VA
2084P0800X
Psychiatry Physician
Primary
297072
NY
2084P0800X
Psychiatry Physician
OS022564
PA
Other
Enumeration date
05/18/2015
Last updated
10/13/2023
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