Healthcare Provider Details

I. General information

NPI: 1376881045
Provider Name (Legal Business Name): 850 PARK SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 PARK AVE 1ST FLOOR
NEW YORK NY
10075-1845
US

IV. Provider business mailing address

850 PARK AVE 1ST FLOOR
NEW YORK NY
10075-1845
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-4040
  • Fax:
Mailing address:
  • Phone: 212-988-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DARRICK ANTELL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 212-988-4040