Provider Demographics
NPI:1053352468
Name:TRISTATE MEDICAL CARE PC
Entity type:Organization
Organization Name:TRISTATE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG
Authorized Official - Middle Name:SIK
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-313-4840
Mailing Address - Street 1:21 GRAND AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1076
Mailing Address - Country:US
Mailing Address - Phone:201-313-4840
Mailing Address - Fax:201-313-9353
Practice Address - Street 1:21 GRAND AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1076
Practice Address - Country:US
Practice Address - Phone:201-313-4840
Practice Address - Fax:201-313-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0718592081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H40164Medicare UPIN