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General NPI Number Information
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NPI Number | 1639552144
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Entity Type | Organization
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Legal Business Name | PARK WEST SURGICAL GROUP LLC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 75 CENTRAL PARK W
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City | NEW YORK
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State | NY
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Zip | 10023-6055
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Country | US
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Telephone | 201-871-4000
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Fax | 201-608-6852
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Provider Business Mailing Address
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Address Line | 75 S DEAN ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3512
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Country | US
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Telephone | 201-862-9300
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Fax | 201-608-6852
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | ARGYRIOS MAVROGIORGIS
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Credential |
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Telephone | 201-862-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery 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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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