Organization
PROMEDEX. INC
Active
Other names
Procare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONG KU PARK (PRESIDENT)
(718) 939-4008
Entity
Organization
Contact information
Practice address
136-71 41AVE, FLUSHING, NY 11355-2433
(718) 939-4008
(718) 939-5508
Mailing address
136-71 41AVE, FLUSHING, NY 11355-2433
(718) 939-4008
(718) 939-5508
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
C49901
—
2251X0800X
Orthopedic Physical Therapist
C0002130
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02709800
—
NY
Enumeration date
12/26/2006
Last updated
07/21/2022
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