Individual
ELEANOR PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-2603
(315) 772-2778
Mailing address
11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-2603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/31/2023
Last updated
07/16/2024
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