DR. TAE KEUN PARK M.D.
NPI 1093940249
Emergency Medicine in Manhasset, NY
About Dr. Tae Keun Park M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. TAE KEUN PARK M.D. (NPI 1093940249) is an individual emergency medicine provider in Manhasset, New York, licensed in New Jersey (25MA08835000) and active in the NPI registry since May 2009. He is enrolled in Medicare PECOS and maintains a secondary practice location in Teaneck.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Tae Keun Park M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Tae Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Mount Holly, NJ 08060
- Reassigned Medicare billing, New Jersey enrollment
- 248 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 11030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MANHASSET, NY 11030
MANHASSET, NY 11030
MANHASSET, NY 11030
MANHASSET, NY 11030
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tae Park's NPI number?
The NPI number for Tae Park is 1093940249. It was assigned to this individual provider in the NPPES registry on May 18, 2009.
Where is Tae Park located?
Tae Park practices at 300 Community Dr Department Of Emergency Medicine, Manhasset, NY 11030. The listed phone number is (516) 562-2925.
What is Tae Park's specialty?
The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.
Is Tae Park enrolled in Medicare?
Yes. Tae Park is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Tae Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tae Park reassigns Medicare benefits to Emergency Physician Services Of New Jersey,professional Association (Mount Holly, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tae Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Tae Park was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Tae Keun Park, M.D. · NPI 1093940249
Emergency Medicine physician in Manhasset, New York. Individual provider, active in the CMS NPPES registry since May 18, 2009.
## Identity
- **NPI:** 1093940249 (Entity type: Individual)
- **Enumerated:** May 18, 2009
- **Primary specialty:** Emergency Medicine · taxonomy 207P00000X
- **State license:** 25MA08835000 (New Jersey)
- **Sole proprietor:** No
## Practice location
- **Address:** 300 COMMUNITY DR, DEPARTMENT OF EMERGENCY MEDICINE, Manhasset, NY 11030-3816
- **Phone:** (516) 562-2925
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Emergency Physician Services Of New Jersey,professional Association (NPI 1831539568, Mount Holly, NJ), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 21, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1093940249) · Data from the CMS NPPES public registry.