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General NPI Number Information
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NPI Number | 1356607782
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Entity Type | Organization
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Legal Business Name | PARK AVENUE MEDICAL IMAGING AND MOMMOGRAPHY
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 330 E 38TH ST APT 44I
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City | NEW YORK
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State | NY
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Zip | 10016-2783
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Country | US
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Telephone | 212-697-4589
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Fax |
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Provider Business Mailing Address
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Address Line | 330 E 38TH ST APT 44I
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City | NEW YORK
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State | NY
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Zip | 10016-2783
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RADIOLOGY
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Name | YEFIM VAYNSELBAUM
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Credential | M.D
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Telephone | 212-697-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 161694
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License Number State | NY
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