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General NPI Number Information
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NPI Number | 1659627628
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Entity Type | Organization
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Legal Business Name | PARK AVENUE CONCIERGE MEDICINE PC
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 10 E 78TH ST SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10075-1713
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Country | US
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Telephone | 212-737-3136
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Fax | 212-737-3481
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Provider Business Mailing Address
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Address Line | 10 E 78TH ST SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10075-1713
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Country | US
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Telephone | 212-737-3136
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Fax | 212-737-3481
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH MULVEHILL
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Credential | M.D.
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Telephone | 212-737-3136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 216111
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License Number State | NY
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