Provider Demographics
NPI:1659373025
Name:PARK AVENUE DERMATOLOGY & PLASTIC SURGERY LLP
Entity Type:Organization
Organization Name:PARK AVENUE DERMATOLOGY & PLASTIC SURGERY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-794-4000
Mailing Address - Street 1:625 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6545
Mailing Address - Country:US
Mailing Address - Phone:212-794-4000
Mailing Address - Fax:212-794-0231
Practice Address - Street 1:625 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6545
Practice Address - Country:US
Practice Address - Phone:212-794-4000
Practice Address - Fax:212-794-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207ND0101X, 207NS0135X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty