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General NPI Number Information
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NPI Number | 1669818324
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Entity Type | Organization
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Legal Business Name | PARK AVENUE AESTHETIC SURGERY, PC
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 461 PARK AVE S FL 7
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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 | 212-206-6465
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Fax | 212-255-2132
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Provider Business Mailing Address
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Address Line | 461 PARK AVE S FL 7
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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 | 212-206-6465
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Fax | 212-255-2132
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. MATT DALLMANN
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Credential |
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Telephone | 212-206-6465
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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 | 183561
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License Number State | NY
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