Healthcare Provider Details

I. General information

NPI: 1841571197
Provider Name (Legal Business Name): MICHAEL L. PARKS, M.D, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

PO BOX 7025
AMAGANSETT NY
11930-7025
US

V. Phone/Fax

Practice location:
  • Phone: 646-797-8995
  • Fax: 646-797-8909
Mailing address:
  • Phone: 631-329-6925
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number202768
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL L. PARKS
Title or Position: OWNER
Credential: M.D.
Phone: 646-797-8995