Healthcare Provider Details

I. General information

NPI: 1669746020
Provider Name (Legal Business Name): PARK AVENUE MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 OAK GROVE AVE
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

3 BARKER AVE 4TH FLOOR
WHITE PLAINS NY
10601-1509
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-1199
  • Fax: 914-949-1245
Mailing address:
  • Phone: 914-949-1199
  • Fax: 914-949-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateVT

VIII. Authorized Official

Name: DR. MITCHEL KAPLAN
Title or Position: PRESIDENT
Credential: MD
Phone: 914-949-1199