Provider Demographics
NPI:1093896888
Name:PARK SURGICAL CO.,INC.
Entity Type:Organization
Organization Name:PARK SURGICAL CO.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-436-9200
Mailing Address - Street 1:5001 NEW UTRECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3547
Mailing Address - Country:US
Mailing Address - Phone:718-436-9200
Mailing Address - Fax:718-854-2431
Practice Address - Street 1:5001 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3547
Practice Address - Country:US
Practice Address - Phone:718-436-9200
Practice Address - Fax:718-854-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00323184Medicaid
NY00323184Medicaid