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

SE Joong Park, DPT

Individual provider Physical Therapist · NPI 1285961177

SE Joong Park, DPT is a Physical Therapist in Private Practice in Bayside, New York. Qualified in 2011, 15 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New York.

Years since qualifying
15
Licensed in
NY
In the registry since
2009
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

4711 Bell Blvd
Bayside, NY 11361-3333
Phone: (718) 423-5100
Fax: (718) 423-5105
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 27912 (NY)

Record details

NPI number1285961177
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorYes
NPI enumeratedNovember 12, 2009
Last updated in NPPESAugust 18, 2020
Certification dateAugust 18, 2020
Mailing address4711 Bell Blvd, Bayside, NY 11361-3333

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Bayside