Provider Demographics
NPI:1235220682
Name:FIFTH AVENUE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FIFTH AVENUE SURGERY CENTER, LLC
Other - Org Name:FRENCH AMERICAN SURGERY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-772-6667
Mailing Address - Street 1:1049 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0115
Mailing Address - Country:US
Mailing Address - Phone:212-772-6667
Mailing Address - Fax:212-988-8018
Practice Address - Street 1:1049 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0115
Practice Address - Country:US
Practice Address - Phone:212-772-6667
Practice Address - Fax:212-988-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002195R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01238288Medicaid
NYANC282OtherOXFORD HEALTH PLANS
NY0455952OtherCIGNA HEALTHCARE
NYNZ0867OtherHEALTH NET
NY003617OtherEMPIRE BLUE CROSS
NY003617OtherEMPIRE BLUE CROSS