Healthcare Provider Details

I. General information

NPI: 1154713725
Provider Name (Legal Business Name): PARK AVENUE TRAUMA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LIVINGSTON ST 2ND FLOOR
BROOKLYN NY
11201-5127
US

IV. Provider business mailing address

100 LIVINGSTON ST 2ND FLOOR
BROOKLYN NY
11201-5127
US

V. Phone/Fax

Practice location:
  • Phone: 718-625-9911
  • Fax:
Mailing address:
  • Phone: 718-625-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GIDEON HEDRYCH
Title or Position: OWNER
Credential:
Phone: 718-625-9911