Provider Demographics
NPI:1235853649
Name:FIFTH AVENUE SURGICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:FIFTH AVENUE SURGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TSOUKALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-250-4958
Mailing Address - Street 1:75 HOLLY HILL LN STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-2912
Mailing Address - Country:US
Mailing Address - Phone:201-357-8888
Mailing Address - Fax:216-482-8082
Practice Address - Street 1:75 HOLLY HILL LN STE 201
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2912
Practice Address - Country:US
Practice Address - Phone:201-357-8888
Practice Address - Fax:216-482-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty