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General NPI Number Information
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NPI Number | 1992987382
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Entity Type | Organization
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Legal Business Name | PARK AVENUE FACIAL SURGERY PLLC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 1040 PARK AVE 86TH STREET
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City | NEW YORK
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State | NY
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Zip | 10028-1032
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Country | US
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Telephone | 212-452-3362
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 PARK AVE 86TH STREET
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City | NEW YORK
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State | NY
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Zip | 10028-1032
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Country | US
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Telephone | 212-452-3362
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | JOELLEN GATELY
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Credential |
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Telephone | 631-732-7426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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