Healthcare Provider Details

I. General information

NPI: 1699969543
Provider Name (Legal Business Name): PARK AVENUE PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DEERWOOD RD
SPRING VALLEY NY
10977-1001
US

IV. Provider business mailing address

12 DEERWOOD RD
SPRING VALLEY NY
10977-1001
US

V. Phone/Fax

Practice location:
  • Phone: 845-671-4000
  • Fax:
Mailing address:
  • Phone: 845-671-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number232596
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SETH D KURTZ
Title or Position: PRESIDENT
Credential: MD
Phone: 917-533-2983