Provider Demographics
NPI:1598436651
Name:PARK AVENUE COLON AND RECTAL SURGERY, PLLC
Entity Type:Organization
Organization Name:PARK AVENUE COLON AND RECTAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-822-0228
Mailing Address - Street 1:36 E 36TH ST OFC 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3463
Mailing Address - Country:US
Mailing Address - Phone:646-822-0228
Mailing Address - Fax:646-822-6793
Practice Address - Street 1:36 E 36TH ST OFC 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3463
Practice Address - Country:US
Practice Address - Phone:646-822-0228
Practice Address - Fax:646-822-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty