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General NPI Number Information
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NPI Number | 1881102267
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Entity Type | Organization
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Legal Business Name | PARK AVENUE PHYSICIANS PC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/27/2018
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Provider Practice Location Address
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Address Line | 5 W 86TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10024-3663
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Country | US
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Telephone | 917-732-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 5 W 86TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10024-3663
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Country | US
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Telephone | 917-732-3990
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELEEZA MANTONE
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Credential |
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Telephone | 917-732-3990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry 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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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