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Contact Information

CHAN W PARK, MD
90 BERGEN STREET- SUITE 8100
DEPARTMENT OF OTOLARYNGOLOGY, DOC BUILDING
NEWARK, NJ07103
 Phone: 973-972-4588
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for CHAN W PARK · (Male)

NPI # 1760644280
Status Active
Credentials MD
Entity Individual
Enumeration date 06/26/2008
Last updated 11/04/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • NJ License # 25MA09356100
  • WA License # MD60287386
  • NY Medicaid 1760644280
Hospital affiliation(s)
  • HACKENSACK UNIVERSITY MEDICAL CENTER - (Acute Care)
    30 PROSPECT AVE
    HACKENSACK, NJ 07601
  • SAINT BARNABAS MEDICAL CENTER - (Acute Care)
    94 OLD SHORT HILLS ROAD
    LIVINGSTON, NJ 07039
  • UMDNJ UNIVERSITY HOSPITAL - (Acute Care)
    150 BERGEN ST
    NEWARK, NJ 07103
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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