Healthcare Provider Details

I. General information

NPI: 1922871417
Provider Name (Legal Business Name): PARK AVENUE ORAL, MAXILLOFACIAL, IMPLANT SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 PARK AVE
NEW YORK NY
10065-8198
US

IV. Provider business mailing address

531 PARK AVE
NEW YORK NY
10065-8198
US

V. Phone/Fax

Practice location:
  • Phone: 212-339-3930
  • Fax:
Mailing address:
  • Phone: 212-339-3930
  • Fax: 212-339-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES CHOI
Title or Position: DOCTOR
Credential: MD, DMD, FACS
Phone: 917-270-9950