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General NPI Number Information
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NPI Number | 1427472828
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Entity Type | Organization
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Legal Business Name | PARK AVENUE FOOT CARE PLLC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 02/06/2014
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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 | 212-744-0423
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Provider Business Mailing Address
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Address Line | 930 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10021-2651
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Country | US
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Telephone | 212-535-0229
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Fax | 212-744-0423
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUZANNE LEVINE
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Credential | DPM
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | N002752-1
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License Number State | NY
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