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General NPI Number Information
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NPI Number | 1235220682
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 1049 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10028-0115
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Country | US
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Telephone | 212-772-6667
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Fax | 212-988-8018
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Provider Business Mailing Address
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Address Line | 1049 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10028-0115
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Country | US
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Telephone | 212-772-6667
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Fax | 212-988-8018
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. CHARLES J RAAB
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Credential |
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Telephone | 212-772-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7002195R
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License Number State | NY
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