CHAN SOO PARK (NPI# 1861485484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861485484 |
| Entity Type | Individual |
| Full Name | CHAN SOO PARK |
| Credential | MD |
| Practice Address |
205 South Ave Suite 103 Poughkeepsie NY 12601-4818 |
| Practice Telephone | 8454542360 |
| Practice Fax Number | 8454542361 |
| Mailing Telephone | 8454542360 |
| Mailing Fax Number | 8454542361 |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
127160 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00503613 | 05 |
| Street Address |
205 SOUTH AVE SUITE 103 |
| City | POUGHKEEPSIE |
| State | NY |
| Zip Code | 12601-4818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053919449 | Kristin Woods | Counselor | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2020-10-16 |
| 1811534852 | Jennifer Lynn Ditrocchio | Counselor | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2019-12-10 |
| 1699310813 | Giovanna Muise | Social Worker | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2019-11-12 |
| 1932767894 | Kristin Montini | Social Worker | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2019-06-04 |
| 1295399434 | Kimberly Marie Marchetti | Social Worker | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2019-04-23 |
| 1629535687 | Julia Helen Smith | Counselor | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2019-02-26 |
| 1043794811 | Kara Ann Cannelli | Counselor | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2018-09-18 |
| 1326555822 | Isabel Claire Cottingham | Social Worker | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2018-01-05 |
| 1700321924 | Robert Maher | Social Worker | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2016-12-24 |
| 1083165997 | Robert Alfred Basil | Social Worker | 205 South Ave, Poughkeepsie, NY 12601-4818 | 2016-10-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194348425 | Hudson Valley Radiologists, PC | Radiology | 57 Kingwood Park, Poughkeepsie, NY 12601 | 2020-05-21 |
| 1063049088 | Jaquellah Taylor | Student in an Organized Health Care Education/Training Program | Vassar Brother Medical Center 45 Reade Place, Poughkeepsie, NY 12601 | 2020-03-27 |
| 1053957050 | Jasmine Syin-lan Miller | Student in an Organized Health Care Education/Training Program | 3399 North Road, Marist College Msc 12617, Poughkeepsie, NY 12601 | 2019-11-25 |
| 1144864224 | Kim Beverly | Technician | 16 Tamidan Road, Poughkeepsle, NY 12601 | 2019-11-01 |
| 1851852768 | Marwa H Abdalla | Student in an Organized Health Care Education/Training Program | Vassar Brother Medical Center, 45 Reade Place, Poughkeepsie, NY 12601 | 2019-03-26 |
| 1619459047 | Victoria Bozydaj | Occupational Therapy Assistant | 50 Rinaldi Boulevard Apt 7r, Poughkeepsie, NY 12601 | 2018-09-01 |
| 1821589953 | Avo Gregory Serafino | Physician Assistant | 228 Donnelly, Poughkeepsie, NY 12601 | 2018-05-24 |
| 1649771486 | Raewyn Kalisha Clayton | Registered Nurse | 31 Forbus Street Apt C2, Poughkeepsie, NY 12601 | 2018-02-27 |
| 1780108761 | Ronica Dorothy White | Licensed Practical Nurse | 7c Muldowney Circle, Poughkeepsie, NY 12601 | 2017-08-01 |
| 1336662048 | Ashley Elizabeth Travers | Licensed Practical Nurse | 100 Innis Ave, Poughkeepsie, NY 12601 | 2017-07-25 |
| Find all providers in zip 12601 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942216437 | Loren Ethan Rosenthal | Psychiatry & Neurology | 69 West Cedar Street, Poughkeepsie, NY 12601 | 2006-08-01 |
| 1457348393 | Uma S Alampur | Psychiatry & Neurology | 207 Washington St Ste 201, Poughkeepsie, NY 12601-8112 | 2005-10-05 |
| 1982697975 | Samuel E. Koszer | Psychiatry & Neurology | 21 Fox Street, Suite 102, Poughkeepsie, NY 12601-4723 | 2005-08-25 |
| 1821090333 | Glenn Y Castaneda | Psychiatry & Neurology | 21 Fox St., Suite 102, Poughkeepsie, NY 12601-4723 | 2005-08-15 |
| 1477117349 | Health Quest Medical Practice, PC | Psychiatry & Neurology | 21 Reade Pl Ste 3100, Poughkeepsie, NY 12601-3944 | 2019-04-26 |
| 1871836072 | Katherine D Amodeo | Psychiatry & Neurology | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2013-04-05 |
| 1588983761 | Justin Ross Marcus | Psychiatry & Neurology | 45 Reade Pl, Poughkeepsie, NY 12601 | 2010-05-26 |
| 1417289307 | Mid Hudson Neurosurgical Specialist, PC | Psychiatry & Neurology | 1 Webster Ave, Suite 307, Poughkeepsie, NY 12601-1361 | 2010-02-03 |
| 1871634246 | Dutchess Neurology, Pllc | Psychiatry & Neurology | 69 W Cedar St, Poughkeepsie, NY 12601-1351 | 2007-02-09 |
| 1295888923 | Jennifer A. Pallone | Psychiatry & Neurology | 21 Reade Pl Ste 1100, Poughkeepsie, NY 12601-3986 | 2007-01-18 |
| Find all providers in POUGHKEEPSIE | ||||
| City | POUGHKEEPSIE |
| Zip Code | 12601 |
Please comment or provide details below to improve the information on CHAN SOO PARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.