Provider Demographics
NPI:1235254392
Name:PARK AVENUE PERDIATRICS
Entity Type:Organization
Organization Name:PARK AVENUE PERDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-239-7001
Mailing Address - Street 1:36 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044
Mailing Address - Country:US
Mailing Address - Phone:973-239-7001
Mailing Address - Fax:973-239-8867
Practice Address - Street 1:36 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044
Practice Address - Country:US
Practice Address - Phone:973-239-7001
Practice Address - Fax:973-239-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty