Healthcare Provider Details

I. General information

NPI: 1619417375
Provider Name (Legal Business Name): 760 PARK ENDOSCOPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 PARK AVE
NEW YORK NY
10021-4152
US

IV. Provider business mailing address

760 PARK AVE
NEW YORK NY
10021-4152
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number478498
License Number StateNY

VIII. Authorized Official

Name: ALBERT B KNAPP
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 212-737-3446