Healthcare Provider Details

I. General information

NPI: 1538232616
Provider Name (Legal Business Name): FIFTH AVENUE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 FIFTH AVENUE
NEW YORK NY
10028
US

IV. Provider business mailing address

994 FIFTH AVENUE
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-3700
  • Fax: 212-327-4506
Mailing address:
  • Phone: 212-327-3700
  • Fax: 212-327-4506

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: THOMAS W LOEB
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 212-327-3700