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

Dr. Innjea Park, DPM

Individual provider Foot & Ankle Surgery Podiatrist · NPI 1174907992

Dr. Innjea Park, DPM is a Podiatry in Staten Island, New York. Graduated from New York College of Podiatric Medicine in 2015, 11 years ago. Practices with Mbip Podiatry PC, a 3-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
11
Trained at
New York College of Podiatric Medicine
Licensed in
NY
In the registry since
2015
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

1042 Huguenot Ave
Staten Island, NY 10312-4315
Phone: (917) 796-1693
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Foot & Ankle Surgery Podiatrist (primary) Taxonomy 213ES0103X · Licence N006887 (NY)

Record details

NPI number1174907992
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorNo
NPI enumeratedJuly 10, 2015
Last updated in NPPESMay 7, 2025
Certification dateMay 7, 2025

Medicare enrollment

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

Medicare specialtyPODIATRY
Medical schoolNEW YORK COLLEGE OF PODIATRIC MEDICINE
Graduated 2015 (11 years in practice)
Group practice Mbip Podiatry Pc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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