MEDICARE: PARK AVENUE ANESTHESIA PLLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1851910327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK AVENUE ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	68 STERLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3319
Country	:	US
Telephone Number	:	917-745-2916
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 STERLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3319
Country	:	US
Telephone Number	:	917-745-2916
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DANIEL J MCDOLE
Credential	:	MD, MBA
Telephone Number	:	917-745-2916

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	01/29/2024

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