Provider Demographics
NPI:1043631021
Name:TAK, PAUL MINSEOK
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MINSEOK
Last Name:TAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1734
Mailing Address - Country:US
Mailing Address - Phone:201-966-7828
Mailing Address - Fax:
Practice Address - Street 1:8655 BROADWAY STE C4
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5868
Practice Address - Country:US
Practice Address - Phone:201-966-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist