MEDICARE: PARK LENOX ORTHOPEDICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	146159	NY

General Provider Information

NPI Number	:	1194957316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK LENOX ORTHOPEDICS, PC

Provider Business Mailing Address
First Line	:	130 E 77TH ST
Second Line	:	11TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10075-1851
Country	:	US
Telephone Number	:	212-434-6880
Fax Number	:	212-434-6888

Provider Business Practice Location Address
First Line	:	7241 GRAND AVE
Second Line	:	GRAND MEDICAL SUITES
City	:	MASPETH
State	:	NY
Zip	:	11378-1532
Country	:	US
Telephone Number	:	718-558-1975
Fax Number	:	718-457-5843

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELLIOTT B. HERSHMAN
Credential	:	M.D.
Telephone Number	:	212-744-8115

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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