Provider Demographics
NPI:1083975353
Name:PARK AVENUE MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:PARK AVENUE MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PUCCINI
Authorized Official - Middle Name:
Authorized Official - Last Name:INOKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-244-8595
Mailing Address - Street 1:303 PARK AVE S
Mailing Address - Street 2:1423
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3601
Mailing Address - Country:US
Mailing Address - Phone:646-244-8595
Mailing Address - Fax:718-355-9661
Practice Address - Street 1:303 PARK AVE S
Practice Address - Street 2:1423
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3601
Practice Address - Country:US
Practice Address - Phone:646-244-8595
Practice Address - Fax:718-355-9661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANGEA GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition