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General NPI Number Information
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NPI Number | 1598436651
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Entity Type | Organization
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Legal Business Name | PARK AVENUE COLON AND RECTAL SURGERY, PLLC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 36 E 36TH ST OFC 1C
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City | NEW YORK
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State | NY
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Zip | 10016-3463
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Country | US
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Telephone | 646-822-0228
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Fax | 646-822-6793
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Provider Business Mailing Address
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Address Line | 36 E 36TH ST OFC 1C
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City | NEW YORK
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State | NY
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Zip | 10016-3463
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Country | US
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Telephone | 646-822-0228
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Fax | 646-822-6793
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARSHA ANN HARRIS
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Credential | MD
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Telephone | 646-822-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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