Provider Demographics
NPI:1023044161
Name:PARK AVENUE MEDICAL PROFESSIONALS
Entity Type:Organization
Organization Name:PARK AVENUE MEDICAL PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-427-2000
Mailing Address - Street 1:120 E 86TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1062
Mailing Address - Country:US
Mailing Address - Phone:212-427-2000
Mailing Address - Fax:212-427-2008
Practice Address - Street 1:120 E 86TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1062
Practice Address - Country:US
Practice Address - Phone:212-427-2000
Practice Address - Fax:212-427-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEP681Medicare PIN