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General NPI Number Information
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NPI Number | 1003182874
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Entity Type | Organization
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Legal Business Name | PARK AVENUE ORTHODONTICS
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 935 PARK AVE SUITE 102
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City | NEW YORK
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State | NY
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Zip | 10028-0212
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Country | US
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Telephone | 212-452-2777
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Fax | 212-452-3363
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Provider Business Mailing Address
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Address Line | 935 PARK AVE SUITE 102
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City | NEW YORK
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State | NY
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Zip | 10028-0212
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Country | US
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Telephone | 212-452-2777
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Fax | 212-452-3363
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Authorized Official
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Title or Position | OWNER
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Name | JANET STOESS-ALLEN
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Credential | D.M.D
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Telephone | 212-452-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 040533
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License Number State | NY
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