Provider Demographics
NPI:1306017199
Name:PARK AVENUE CARDIOLOGY PC
Entity Type:Organization
Organization Name:PARK AVENUE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-9000
Mailing Address - Street 1:1036 PARK AVE
Mailing Address - Street 2:SUTIE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0971
Mailing Address - Country:US
Mailing Address - Phone:212-879-9000
Mailing Address - Fax:212-535-3344
Practice Address - Street 1:1036 PARK AVE
Practice Address - Street 2:SUTIE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0971
Practice Address - Country:US
Practice Address - Phone:212-879-9000
Practice Address - Fax:212-535-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196704207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY196704OtherLICENSE