Individual
DR. TINA PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 342-4776
Mailing address
630 W 168TH ST, NEW YORK, NY 10032-3725
(212) 342-5155
(401) 444-2947
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
LP01591
RI
207RG0100X
Gastroenterology Physician
Primary
277511
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277511
NYS MED LICENSE
NY
Enumeration date
06/25/2009
Last updated
04/29/2019
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