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

Shane Park

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1992551139

Shane Park is a Student in an Organized Health Care Education/Training Program in Newark, New Jersey. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

110 Bergen St
Newark, NJ 07103-2495
Phone: (973) 972-4620
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1992551139
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 29, 2024
Last updated in NPPESApril 29, 2024
Certification dateApril 28, 2024
Mailing address110 Bergen St, Newark, NJ 07103-2495

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