Provider Demographics
NPI:1215015417
Name:PARK 55 MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PARK 55 MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZIECHECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:212-758-3590
Mailing Address - Street 1:110 E 55TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4540
Mailing Address - Country:US
Mailing Address - Phone:212-758-3590
Mailing Address - Fax:212-486-0640
Practice Address - Street 1:110 E 55TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4540
Practice Address - Country:US
Practice Address - Phone:212-758-3590
Practice Address - Fax:212-486-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWANN11Medicare PIN