Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Charles W. Park, MD

Individual provider Mental Health Counselor · NPI 1629179411

Dr. Charles W. Park, MD is a Psychiatry in West Orange, New Jersey. Graduated from University of Missouri, Columbia School of Medicine in 1998, 28 years ago. Accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
28
Trained at
University of Missouri, Columbia School of Medicine
Licensed in
NJ
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

405 Northfield Ave Ste 204
West Orange, NJ 07052-3026
Phone: (973) 325-6120
Fax: (973) 325-6126
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 25MA07374100 (NJ)
Mental Health Counselor Taxonomy 101YM0800X · Licence 25MA07374100 (NJ)

Record details

NPI number1629179411
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 26, 2006
Last updated in NPPESDecember 18, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolUNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Graduated 1998 (28 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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