Basic Information
| Provider Information | |||||||||
| NPI: | 1346894482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | HYO SOON | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 FOREST ST | ||||||||
| Address2: | |||||||||
| City: | CLOSTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076241002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019165485 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 DEAN DR FL 1 | ||||||||
| Address2: | |||||||||
| City: | TENAFLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076702765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015688288 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2019 | ||||||||
| LastUpdateDate: | 08/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 26NJ00939200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.