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General NPI Number Information
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NPI Number | 1518035401
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Entity Type | Organization
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Legal Business Name | PARK UROLOGIC, PC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 461 PARK AVE S 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-6822
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Country | US
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Telephone | 212-679-6464
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Fax | 212-679-6472
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Provider Business Mailing Address
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Address Line | 461 PARK AVE S 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-6822
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Country | US
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Telephone | 212-679-6464
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Fax | 212-679-6472
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES L KNOLL
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Credential | MD
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Telephone | 212-679-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | NY
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