Healthcare Provider Details

I. General information

NPI: 1003805219
Provider Name (Legal Business Name): PARK AVENUE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 PARK AVE S FLOOR 2
NEW YORK NY
10016-7390
US

IV. Provider business mailing address

451 PARK AVE S FLOOR 2
NEW YORK NY
10016-7390
US

V. Phone/Fax

Practice location:
  • Phone: 212-779-0202
  • Fax: 212-779-1521
Mailing address:
  • Phone: 212-779-0202
  • Fax: 212-779-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number202594
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number202594
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number202594
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number202594
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number213773
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number158015
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number136143
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number158015
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number158015
License Number StateNY
# 10
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number213773
License Number StateNY

VIII. Authorized Official

Name: DR. JOSE ROLANDO SANCHEZ-PEA
Title or Position: PRESIDENT / CEO
Credential: MD
Phone: 212-779-0202