Organization
PRIME DIAGNOSTICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANG S PARK M.D. (OWNER)
20148200439
Entity
Organization
Contact information
Practice address
118 BROAD AVE, N9, PALISADES PARK, NJ 07650-2717
(201) 482-0439
Mailing address
118 BROAD AVE, N9, PALISADES PARK, NJ 07650-2717
(201) 482-0439
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA07699600
NJ
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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