Healthcare Provider Details

I. General information

NPI: 1740601640
Provider Name (Legal Business Name): PARK AVENUE PEDIATRICS OF MANHATTAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PARK AVE
NEW YORK NY
10128-1234
US

IV. Provider business mailing address

1111 PARK AVE
NEW YORK NY
10128-1234
US

V. Phone/Fax

Practice location:
  • Phone: 212-534-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number218733
License Number StateNY

VIII. Authorized Official

Name: DR. PHILIPPE LOUIS SIMILON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-534-3000