Healthcare Provider Details

I. General information

NPI: 1659373025
Provider Name (Legal Business Name): PARK AVENUE DERMATOLOGY & PLASTIC SURGERY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 PARK AVE
NEW YORK NY
10021-6545
US

IV. Provider business mailing address

625 PARK AVE
NEW YORK NY
10021-6545
US

V. Phone/Fax

Practice location:
  • Phone: 212-794-4000
  • Fax: 212-794-0231
Mailing address:
  • Phone: 212-794-4000
  • Fax: 212-794-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT H GOTKIN
Title or Position: PARTNER
Credential: MD
Phone: 212-794-4000