Provider Demographics
NPI:1003182874
Name:PARK AVENUE ORTHODONTICS
Entity Type:Organization
Organization Name:PARK AVENUE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:STOESS-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-452-2777
Mailing Address - Street 1:935 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0212
Mailing Address - Country:US
Mailing Address - Phone:212-452-2777
Mailing Address - Fax:212-452-3363
Practice Address - Street 1:935 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0212
Practice Address - Country:US
Practice Address - Phone:212-452-2777
Practice Address - Fax:212-452-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0405331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty