Provider Demographics
NPI:1003805219
Name:PARK AVENUE MEDICAL PLLC
Entity Type:Organization
Organization Name:PARK AVENUE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ROLANDO
Authorized Official - Last Name:SANCHEZ-PEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-779-0202
Mailing Address - Street 1:451 PARK AVE S
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7390
Mailing Address - Country:US
Mailing Address - Phone:212-779-0202
Mailing Address - Fax:212-779-1521
Practice Address - Street 1:451 PARK AVE S
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7390
Practice Address - Country:US
Practice Address - Phone:212-779-0202
Practice Address - Fax:212-779-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158015207R00000X, 207RG0300X, 207RP1001X
NY136143207R00000X
NY213773207R00000X, 207RI0200X
NY2025942085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00836824Medicaid
NYWES-511Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NY00836824Medicaid
NYF03049Medicare UPIN
NY17Y302Medicare ID - Type UnspecifiedDR. ALI MEDICARE #
NY440501Medicare ID - Type UnspecifiedDR. PICHARDO MEDICARE #
NY20D363Medicare ID - Type UnspecifiedDR. SANCHEZ MEDICARE ID