Individual
BUM Y PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4010 70TH ST, WOODSIDE, NY 11377-2930
(718) 899-4600
(718) 446-8302
Mailing address
4010 70TH ST, WOODSIDE, NY 11377-2930
(718) 899-4600
(718) 446-8302
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
168409
NY
208D00000X
General Practice Physician
Primary
168409
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01008740
—
NY
Enumeration date
02/01/2006
Last updated
10/21/2024
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