Healthcare Provider Details

I. General information

NPI: 1083801666
Provider Name (Legal Business Name): FIFTH AVENUE MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 MADISON AVE 6TH FLOOR
NEW YORK NY
10065-8404
US

IV. Provider business mailing address

PO BOX 270
MASSAPEQUA PARK NY
11762-0270
US

V. Phone/Fax

Practice location:
  • Phone: 212-702-0123
  • Fax:
Mailing address:
  • Phone: 631-264-2035
  • Fax: 631-264-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALBERT HARARY
Title or Position: OWNER
Credential: M.D.
Phone: 631-264-2035