Healthcare Provider Details

I. General information

NPI: 1235397290
Provider Name (Legal Business Name): PARK AVENUE MEDICAL FAMILY & GERIATRICS,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK AVE
YONKERS NY
10703-2934
US

IV. Provider business mailing address

102 PARK AVE
YONKERS NY
10703-2934
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-4300
  • Fax:
Mailing address:
  • Phone: 914-965-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number148454
License Number StateNY

VIII. Authorized Official

Name: MR. AARON FELDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-239-7093