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General NPI Number Information
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NPI Number | 1154874899
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Entity Type | Organization
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Legal Business Name | PARK NYC MEDICAL OFFICE, P.C.
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 885 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10075-0325
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Country | US
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Telephone | 212-535-0229
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Fax |
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Provider Business Mailing Address
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Address Line | 885 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10075-0325
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Country | US
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Telephone | 212-535-0229
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EVERETT MARC LAUTIN
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Credential | M.D.
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Telephone | 212-535-0229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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