Healthcare Provider Details

I. General information

NPI: 1235853649
Provider Name (Legal Business Name): FIFTH AVENUE SURGICAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOLLY HILL LN STE 201
GREENWICH CT
06830-2912
US

IV. Provider business mailing address

75 HOLLY HILL LN STE 201
GREENWICH CT
06830-2912
US

V. Phone/Fax

Practice location:
  • Phone: 201-357-8888
  • Fax: 216-482-8082
Mailing address:
  • Phone: 201-357-8888
  • Fax: 216-482-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL A TSOUKALAS
Title or Position: EXEC DIRECTOR
Credential:
Phone: 917-250-4958