Provider Demographics
NPI:1669818324
Name:PARK AVENUE AESTHETIC SURGERY, PC
Entity Type:Organization
Organization Name:PARK AVENUE AESTHETIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-206-6465
Mailing Address - Street 1:461 PARK AVE S FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6822
Mailing Address - Country:US
Mailing Address - Phone:212-206-6465
Mailing Address - Fax:212-255-2132
Practice Address - Street 1:461 PARK AVE S FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6822
Practice Address - Country:US
Practice Address - Phone:212-206-6465
Practice Address - Fax:212-255-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty