MEDICARE: PARK AVENUE MEDICAL EQUIPMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)

General Provider Information

NPI Number	:	1083975353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK AVENUE MEDICAL EQUIPMENT LLC

Provider Business Mailing Address
First Line	:	303 PARK AVE S
Second Line	:	1423
City	:	NEW YORK
State	:	NY
Zip	:	10010-3601
Country	:	US
Telephone Number	:	646-244-8595
Fax Number	:	718-355-9661

Provider Business Practice Location Address
First Line	:	303 PARK AVE S
Second Line	:	1423
City	:	NEW YORK
State	:	NY
Zip	:	10010-3601
Country	:	US
Telephone Number	:	646-244-8595
Fax Number	:	718-355-9661

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. PUCCINI INOKON
Credential	:
Telephone Number	:	646-244-8595

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	06/04/2012

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