Provider Demographics
NPI:1356453393
Name:PARK AVENUE ORTHOTICS, INC.
Entity Type:Organization
Organization Name:PARK AVENUE ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSCHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-297-0362
Mailing Address - Street 1:155 E 55TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4051
Mailing Address - Country:US
Mailing Address - Phone:212-297-0362
Mailing Address - Fax:212-697-3697
Practice Address - Street 1:155 E 55TH ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4051
Practice Address - Country:US
Practice Address - Phone:212-297-0362
Practice Address - Fax:212-697-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0903196332B00000X
MDCZ1985335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01907175Medicaid
NY0150410001Medicare NSC