Healthcare Provider Details

I. General information

NPI: 1760607501
Provider Name (Legal Business Name): PARK PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MADISON AVE ROOM 605
NEW YORK NY
10016-0701
US

IV. Provider business mailing address

274 MADISON AVE ROOM 605
NEW YORK NY
10016-0701
US

V. Phone/Fax

Practice location:
  • Phone: 212-532-8278
  • Fax: 212-532-7021
Mailing address:
  • Phone: 212-532-8278
  • Fax: 212-532-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005363
License Number StateNY

VIII. Authorized Official

Name: DR. ANTHONY C. GUARINO
Title or Position: OWNER
Credential: D.P.M.
Phone: 212-532-8278