MEDICARE: PARK AVENUE CARDIOLOGY 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	207RC0000X	Cardiovascular Disease Physician	196704	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196704	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1306017199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK AVENUE CARDIOLOGY PC

Provider Business Mailing Address
First Line	:	1036 PARK AVE
Second Line	:	SUTIE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10028-0971
Country	:	US
Telephone Number	:	212-879-9000
Fax Number	:	212-535-3344

Provider Business Practice Location Address
First Line	:	1036 PARK AVE
Second Line	:	SUTIE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10028-0971
Country	:	US
Telephone Number	:	212-879-9000
Fax Number	:	212-535-3344

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM DEUTSCH
Credential	:	MD
Telephone Number	:	212-879-9000

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	08/25/2014

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