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General NPI Number Information
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NPI Number | 1861577041
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Entity Type | Organization
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Legal Business Name | PARK AVENUE REHABILITATION LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 323 60TH ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5412
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Country | US
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Telephone | 201-861-6800
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Fax | 201-861-6803
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Provider Business Mailing Address
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Address Line | 323 60TH ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5412
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Country | US
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Telephone | 201-861-6800
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Fax | 201-861-6803
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JOSEPH A MEZYK
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Credential | D.C.
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Telephone | 201-861-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC2969
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License Number State | NJ
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