Individual
CHAN SOO PARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 SOUTH AVE, SUITE 103, POUGHKEEPSIE, NY 12601-4818
(845) 454-2360
(845) 454-2361
Mailing address
205 SOUTH AVE, SUITE 103, POUGHKEEPSIE, NY 12601-4818
(845) 454-2360
(845) 454-2361
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
127160
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00503613
—
NY
Enumeration date
08/30/2005
Last updated
07/08/2007
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