Healthcare Provider Details

I. General information

NPI: 1043377427
Provider Name (Legal Business Name): PARK LENOX PEDIATRIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10021-1850
US

IV. Provider business mailing address

100 E 77TH ST
NEW YORK NY
10021-1850
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2136
  • Fax: 212-434-3374
Mailing address:
  • Phone: 212-434-2136
  • Fax: 212-434-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ARMANDO E GRASSI
Title or Position: PRESIDENT
Credential: MD
Phone: 212-434-2136