Park Avenue Medical Office, PLLC
Internal Medicine, Allergy & Immunology in New York, NY. Organization (NPI-2).
NPI number1013568435
StatusActive
Last updated in NPPESSep 26, 2019
Details
- NPI
- 1013568435
- Entity type
- Organization (NPI-2)
- Legal business name
- Park Avenue Medical Office, PLLC
- Organization subpart
- No
- Enumeration date
- Sep 26, 2019
- Last updated
- Sep 26, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RA0201X | Internal Medicine, Allergy & Immunology | – | – | Yes |
Practice location
642 Park AveNew York, NY 10065-6105
Phone 212-517-6611 · Fax 212-517-2132
Mailing address
642 Park AveNew York, NY 10065-6105
Phone 212-517-6611 · Fax 212-517-2132
Authorized official
Wellington S Tichenor
Owner
2125176611
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