MEDICARE: PARK AVENUE SURGICAL ASSOCIATES, P.C.

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1205937968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK AVENUE SURGICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1175 PARK AVE
Second Line	:	SUITE 1 C
City	:	NEW YORK
State	:	NY
Zip	:	10128-1211
Country	:	US
Telephone Number	:	212-369-2222
Fax Number	:	212-348-1392

Provider Business Practice Location Address
First Line	:	1175 PARK AVE
Second Line	:	SUITE 1 C
City	:	NEW YORK
State	:	NY
Zip	:	10128-1211
Country	:	US
Telephone Number	:	212-369-2222
Fax Number	:	212-348-1392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRA H FRIEDMAN
Credential	:	M.D.
Telephone Number	:	212-369-2222

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/13/2015

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