Healthcare Provider Details

I. General information

NPI: 1902028046
Provider Name (Legal Business Name): PARK AVENUE DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E 33RD ST SUITE 205
NEW YORK NY
10016-5336
US

IV. Provider business mailing address

45 E 33RD ST SUITE 205
NEW YORK NY
10016-5336
US

V. Phone/Fax

Practice location:
  • Phone: 212-594-7171
  • Fax: 212-447-0896
Mailing address:
  • Phone: 212-594-7171
  • Fax: 212-447-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number031739
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049431
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number034207
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number046794
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0200851
License Number StateNY

VIII. Authorized Official

Name: DR. RAJESH I KAMDAR
Title or Position: PRESIDENT
Credential: DDS
Phone: 212-594-7171