DR. INNJEA PARK DPM NPI 1174907992

NPI Information

  • NPI: 1174907992
  • Provider Name: DR. INNJEA PARK, DPM
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1042 HUGUENOT AVE
    STATEN ISLAND, NY
    ZIP 10312
  • Phone: (917) 796-1693

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NPI Details

DR. Innjea Park, DPM is a foot and ankle surgery podiatrist in Staten Island, NY with 11 years of experience. DR. Innjea Park, DPM NPI is 1174907992. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: NEW YORK COLLEGE OF PODIATRIC MEDICINE
Graduation Year:2015

The provider's business location address is:

1042 HUGUENOT AVE
STATEN ISLAND, NY
ZIP 10312-315
Phone: (917) 796-1693

The NPI 1174907992 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Removal of fingernails or toenails, 6 or more nails (HCPCS:11721)
  • X-ray of foot, minimum of 3 views (HCPCS:73630)
  • Established patient office or other outpatient visit, 10-19 minutes (HCPCS:99212)
  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)

The enumeration date for this NPI number is 7/10/2015 and was last updated on 5/7/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0103XPodiatristFoot & Ankle SurgeryN006887NEW YORKYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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